After years of overtreatment for men with low-risk prostate cancer, the practice of active surveillance/watchful waiting increased sharply in 2010 through 2013. At the same time, high-risk disease was more often treated with potentially curative local treatment rather than with androgen deprivation therapy alone, though not in patients aged 75 and older.
Those are key findings from a snapshot of data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a registry that since 1995 has accrued men with prostate cancer diagnosed at 45 urology practices in the United States.
In a JAMA article published online on July 7, Dr. Matthew R. Cooperberg and Dr. Peter R. Carroll, of the department of urology at the University of California, San Francisco, reported findings from 10,472 men included in the analysis. Their mean age was 66 years and their median Cancer of the Prostate Risk Assessment (CAPRA) score was 2.
Surveillance for low-risk prostate cancer varied between 7% and 14% from 1990 through 2009, but increased to 40% between 2010 through 2013 (P less than .001). At the same time, treatment with androgen deprivation for intermediate- and high-risk tumors, which had been increasing between 1990 through 2009 (to 10% and 30%, respectively), decreased sharply (to 4% and 24%).
The researchers found that among men aged 75 and older, the rate of surveillance was 54% from 1990 through 1994, decreased to 22% from 2000 through 2004, and increased to 76% from 2010 through 2013. “There was an increase in the use of surgery for men aged 75 years or older with low-risk cancer to 9.5% and intermediate-risk cancer to 15%,” they wrote. “However, these was not an increase in use for those with high-risk cancer, among whom androgen deprivation accounted for 66.7% of treatment.”
Rates of overall surveillance among participating centers ranged widely during the time period studied, from 8% to 64%.
“Given that overtreatment of low-risk disease is a major driver of arguments against prostate cancer screening efforts, these observations may help inform a renewed discussion regarding early detection policy in the United States,” the authors concluded.
CapSURE is currently funded by a grant from the U.S. Department of Defense and by UCSF. Dr. Cooperberg disclosed that he has received grants and personal fees from Myriad Genetics, grants from Genomic Health and GenomeDx, and personal fees from Dendreon, Astellas, and Bayer. Dr. Carroll reported having no financial disclosures.