A study examined geographic variations in active surveillance (AS) for low-risk prostate cancer and found that Hispanic ethnicity, Medicaid enrollment, and T category were associated with a lower likelihood of AS.
“AS is now recognized as the preferred management option for most low-risk prostate cancers to minimize risks of overtreatment. Despite increasing use of AS in the US, wide regional variability has been observed, and these regional variations in contemporary practice have not been well described,” the study authors explained. They therefore sought to compare AS between county and Surveillance, Epidemiology, and End Results (SEER) regions.
Data from the SEER Prostate with Watchful Waiting (WW) database linked to the County Area Health Resource File spanning January 2010 through December 2015 were collected.
Final analysis included 79,825 men with clinically localized, low-risk prostate cancer eligible for AS or WW. The mean age of the cohort was 62.8 years (standard deviation, 7.6 years), 11,292 men were Black, and 7,506 were Hispanic. Over the study period, the mean annualized percent increase in AS rates was as low as 6.3% in New Mexico and as high as 81.0% in New Jersey; variations in SEER regions made up 17% of the overall AS variations. The odds of AS increased with age (51-60 years: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.21-1.46; 61-70 years: OR, 1.86; 95% CI, 1.70-2.04; 71-80 years: OR, 2.26; 95% CI, 2.05-2.50).
Factors associated with lower odds of AS were Hispanic ethnicity (OR, 0.79; 95% CI, 0.74-0.85), T category (OR, 0.79; 95% CI, 0.73-0.84), and Medicaid enrollment (OR, 0.73; 95% CI, 0.66-0.81). No correlation was observed between AS and Black race, household income, educational level, city type, and specialist densities.
The study was published in JAMA Network Open.
“Future policy efforts should aim to both continue the overall increase in AS and WW use across the country and reduce variation influenced by nonclinical factors,” the researchers concluded.