MP38-17 PROSTATE CANCER GRADE MIGRATION AND FACILITY-LEVEL TREATMENT TRENDS FOR LOW GRADE DISEASE

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP38-17 PROSTATE CANCER GRADE MIGRATION AND FACILITY-LEVEL TREATMENT TRENDS FOR LOW GRADE DISEASE Leonardo Borregales, Michael Tzeng, Ashwin Ramaswamy, Xiangmei Gu, Meenakshi Davuluri, Himanshu Nagar, and Jim Hu Leonardo BorregalesLeonardo Borregales More articles by this author , Michael TzengMichael Tzeng More articles by this author , Ashwin RamaswamyAshwin Ramaswamy More articles by this author , Xiangmei GuXiangmei Gu More articles by this author , Meenakshi DavuluriMeenakshi Davuluri More articles by this author , Himanshu NagarHimanshu Nagar More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overtreatment of low-grade prostate cancer (PCa) reflect poor quality of care and prompted changes to guidelines over the past decade. Active surveillance (AS) is the preferred choice for low-grade PCa, due to excellent oncological safety and ability to mitigate the consequences of definitive treatment. Nonetheless, uptake of AS in the US continues to lag behind other healthcare systems, such as Sweden, where implementation for GG (Gleason grade group) 1 disease reached 74% by 2014.The lack of AS adoption has been attributed to significant heterogeneity in facility-level practice patterns in the US. Contemporary trends in GG1 PCa management can inform policymakers and guide future initiatives. We sought to characterize trends in the incidence of GG1 disease at biopsy and prostatectomy pathology and assess treatment variability by facility type. METHODS: Men with newly diagnosed PCa between 2010-2019 were identified in the National Cancer Database. Analysis of trends in GG distribution included 1,024,607 men in the biopsy cohort and 511,199 men in the RP cohort. Analysis of treatment trends (AS vs. RP, radiation therapy [RT], focal therapy [FT], or androgen deprivation therapy [ADT]) of localized GG1 PCa according to facility type included 249,585 men. Patients with unknown stage/grade, treatment, or facility type were excluded. Facility was defined as academic (academic/research program) vs. non-academic (community cancer program, comprehensive community cancer program, or integrated network cancer program). AS was defined per the NCDB variable “RX_SUMM_TREATMENT_STATUS” code 2(AS). Joinpoint Regression Program 4.9.0.1 was used for joinpoint analysis. RESULTS: From 2010-2019, GG1 PCa incidence significantly declined from 45% to 25% at biopsy and from 33% to 10% at RP pathology. Among academic sites, use of AS increased from 12% to 62% (AAPC=21%, 95% CI [19,22]), RP decreased from 61% to 25% (AAPC=-9.3%, 95%CI [-10, -8.5]), and RT from 25% to 12% (AAPC=-7.9%, 95%CI [-8.8, -7.0]). Similar trends were seen in nonacademic sites, AS increased from 5% to 49% (AAPC=28%, 95% CI [24,32]), RP decreased from 54% to 28% (AAPC=-6.9%, 95% CI [-8.7, -5.2]), and RT from 38% to 22% (AAPC=-5.9%, 95% CI [-6.6, -5.3]), p<0.001 for all trends. ADT and FT were scarcely utilized, with less than 1% of men receiving such therapies by 2019 at any level. CONCLUSIONS: Declines in the diagnosis and treatment of GG1 disease demonstrate a positive shift in PCa epidemiology and proper stewardship of PCa screening. Nonetheless, heterogeneity in AS utilization remains and reflects opportunities for improvement. Source of Funding: This work was supported by the National Institute of Health (R01 CA241758, R01 CA259173-01A1 to J.C.H); and Patient-Centered Outcomes Research Institute (CER-2019C1-15682, CER-2019C2- 17372 to J.C.H). J.C.H. and L.D.B, receive salary support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust, J.C.H, receives salary support from Prostate Cancer Challenge Award. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e531 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonardo Borregales More articles by this author Michael Tzeng More articles by this author Ashwin Ramaswamy More articles by this author Xiangmei Gu More articles by this author Meenakshi Davuluri More articles by this author Himanshu Nagar More articles by this author Jim Hu More articles by this author Expand All Advertisement PDF downloadLoading ...