Abstract
To investigate sociodemographic factors influencing decision of initially active surveillance (AS) prostate cancer (PCa) patients to opt for definitive therapy, and, specifically, choice of radical prostatectomy (RP) versus radiation therapy (XRT). The Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database was used to identify AS patients diagnosed with NCCN low-risk PCa between 2010 and 2015. We sought to determine predictors of treatment type using multivariable logistic regression analyses. Out of 32,874 men included, 21,255 (64.7%) underwent delayed treatment, with 3,751 (17.6%) and 17,463 (82.2%) opting for RP and XRT, respectively. Patients who were married (Odds Ratio [OR]: 1.18, p <0.001), insured (OR 2.94, p<0.001), of higher socioeconomic status (OR 1.67 for highest versus lowest, p<0.01), and residing in a Southeastern or Midwestern region (ORs 1.26 and 1.22 versus Northeast, respectively, p<0.01) were significantly more likely to undergo definitive intervention. A significant interaction between patient race and marital/socioeconomic statuses on the decision-making process was identified. Decision for XRT (versus RP) was more likely in older (OR 11.6 for 70-79 versus 50-59 years, p<0.01), unmarried (OR 1.89, p<0.01), African American (OR 1.41, p 0.018), and higher socioeconomic status (OR 1.54 for highest versus lowest quartile, p<0.01) patients. The majority of patients initially treated with AS underwent delayed treatment. After accounting for pathologic characteristics, the interaction of sociodemographic factors including race, socioeconomic status, marital status, insurance status and region of residence are significantly associated with the likelihood of undergoing definitive therapy.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call