Increase in Conservative Management of Veterans with Low-Risk Prostate Cancer Suggests Reduction in Over-Treatment
BACKGROUND:
Low-risk prostate cancer has a favorable prognosis without treatment. Current guidelines recommend conservative management or deferring upfront treatment as the preferred approach, but previous studies reported under-utilization in the United States, compared with other countries. Thus, investigators assessed utilization of conservative management among Veterans by examining treatment patterns for Veterans diagnosed with low-risk prostate cancer (n=125,083) from 1/05 through 11/15, with follow up through 11/17. Untreated Veterans were classified as receiving conservative management through either active surveillance (> 2 PSAs and 1 biopsy within 2 years after diagnosis) or watchful waiting.
FINDINGS:
- Utilization of conservative management increased among both men younger than 65 years (27% in 2005 to 72% in 2015) and those 65 or older (35% in 2005 to 79% in 2015). The increase was primarily due to greater use of active surveillance.
- Among Veterans diagnosed with low-risk prostate cancer, 52% (n=65,142) were treated and 48% (n=59,941) received conservative management.
- Of those who received conservative management, 30% (n=37,717) received watchful waiting and 18% (n=22,224) received active surveillance.
IMPLICATIONS
Utilization of conservative management has increased significantly among Veterans with low-risk prostate cancer, suggesting a substantial reduction in over-treatment during the past decade.
LIMITATIONS:
- There may have been misclassification or non-detection of treatment received outside VA.
- Investigators had difficulty distinguishing active surveillance vs. watchful waiting using adminstrative codes.
AUTHOR/FUNDING INFORMATION:
This study was partly supported by an HSR&D Career Development Award to Dr. Makarov, who is part of the Manhattan VA Medical Center in New York.
Loeb S, Byrne N, Makarov D, Lepor H, Walter D. Use of Conservative Management for Low-Risk Prostate Cancer in the Veterans Affairs Integrated Health Care System from 2005-2015. Research Letter. JAMA. June 5, 2018;319(21):2231-2233.
