Use of active surveillance in young men with low-risk prostate cancer.

Abstract

404 Background: Prostate cancer is the second most common cancer in men. The adoption of prostate specific antigen (PSA) screening has led to earlier diagnoses in more localized stages. With radical therapy for low-risk disease often being associated with long term morbidities without clear survival benefit, active surveillance has emerged as a safe strategy with level 1 evidence showing comparable outcomes to surgery or radiation. Despite guidelines recommending active surveillance as the management strategy of choice, recent literature suggests that younger individuals with low-risk prostate cancer still pursue treatment. As such, the goal of this study is to use the National Cancer Database (NCDB) to understand recent trends in active surveillance use among younger men with low risk, localized prostate cancer. Methods: We performed a retrospective study using the NCDB database from 2018-2022 to identify individuals diagnosed with NCCN low risk or very low risk prostate cancer and evaluated treatment strategies based on age quartile. Treatment strategies were defined as partial/complete prostatectomy or entire/partial prostate radiation, and no treatment. Other measured values included PSA, Gleason grade clinical, number of positive biopsy cores, and >50% total cores positive. Results: A total of 103,596 men were included in this analysis. Treatment was pursued in 45.45%, 39.41%, 37.06%, and 29.99% of men in age quartiles 1 (< 59 years), 2 (60-65 years), 3 (66-71 years), and 4 (> 71 years), respectively (Table 1). Chi-square test showed significant differences between the quartiles (p<0.00001). Additionally, multivariable logistic regression analysis including age, Gleason grade clinical, PSA, number of positive cores, and >50% total positive cores, demonstrated that age was an independent predictor of receiving treatment (p<0.001). Conclusions: In this retrospective analysis of the NCDB, young men with NCCN low/very low risk prostate cancer had high rates of definitive treatment. A young age of diagnosis was independently associated with the likelihood of receiving definitive treatment irrespective of other clinicopathologic factors, suggesting that active surveillance is underutilized in young men with localized, low risk disease. The NCCN low/very low-risk group’s active surveillance, treatment, and no treatment distribution. Low-Risk Quartiles 18-59 60-65 66-71 72-90 Total Active Surveillance 12974 14822 14926 8292 51014 Surgery 9712 7548 6248 3859 27367 Radiation 2656 3446 3843 2517 12462 No Treatment 1548 1731 1838 6394 11511 Unknown 323 348 376 195 1242