Evolving Landscape of Practice Patterns in the Management of Localized Low-Risk Prostate Cancer: A NCDB Study

Abstract

Introduction: Most patients with low-risk prostate cancer (LRPC) are candidates for active surveillance (AS) or definitive local treatment, including radical prostatectomy (RP), external beam radiotherapy (EBRT), or prostate seed implant (PSI). In this study, we analyzed the treatment pattern of patients with LRPC using a large patient population provided by the National Cancer Database (NCDB). Methods: Patients with LRPC, as defined by the National Comprehensive Cancer Network criteria, between 2004 and 2015 from the NCDB were analyzed. Patients, with no or minimal comorbidity, were categorized according to treatment modalities, including RP, EBRT, PSI, and no local therapy (NLT). Chi-square tests were used to analyze the association among demographic variables and treatments. Multivariate logistic regression analyses were conducted to determine the likelihood of choosing NLT. Results: In total, 195,452 patients diagnosed with LRPC between 2004 and 2015 were identified. There was a significant change in practice patterns with increased utilization of NLT over time, from 11.3% in 2004 to 53.5% in 2015, with a turning point in 2009. RP utilization peaked at 41.6% in 2008, EBRT peaked at 24.3% in 2006, and PSI peaked at 35.3% in 2004. However, it dropped to 17.6%, 18.1%, and 10.8%, respectively, in 2015. Academic/research programs (A/RP), older age, lower income, poorer education, lack of insurance, African Americans, and other races were associated with increased NLT use. The difference between White and African American, and older and younger patients in odds ratios were less after 2010. Conclusions: There was a significant shift in treatment patterns between 2004 and 2015. AS, as represented by the NLT in this study, has become the dominant treatment of choice for patients with LRPC. A/RPs were leading this trend, particularly in younger patients. Socioeconomic factors played roles in choosing NLT, but the racial difference became less apparent after 2010.