Trends in utilization of active surveillance, treatment, and survival in prostate cancer: Insights from the National Cancer Database (NCDB) analysis.

Abstract

e17138 Background: Active surveillance (AS) is one of the standard approach recommended for most prostate cancer men with low-risk prostate cancer. We examine the incidence of diagnosis, patterns of utilization of no treatment/active surveillance (AS) versus active treatment (Tx), clinical characteristics and trends of stage IV prostate cancer diagnosis in the United States using a hospital-based database. Methods: The National Cancer Database (NCDB) was queried with data including years 2010 – 2021. Demographics including race, and facility type, insurance, income type, Charlson-Deyo score (CDS) comorbidities, Staging, Gleason score, PSA, and treatment, AS were obtained. Trends and survival analyses were calculated. Results: There were 1137698 White (W) men, 220056 Black (B) men, and 69928 Hispanic (H) in the cohort. Median age for men on AS and treatment (Tx) was 66 y/o, median PSA was 6.4 ng/ml (AS) vs 7.8 ng/ml (Tx); AS was given in 149,340 W and 30,682 B and 10,062 H. AS occurred more in academic/research programs (44.6%) while Tx was given in 37.7%. There were significant difference in the rates of AS compared to Tx regarding median income and urban setting (p<.0001), and there were increased use of AS for stage I and II cancers (55.4% and 28.6% compared to those who had Tx 14.8% and 52.1% respectively), Gleason 3+3=6 (AS=32.2% vs 4.6% Tx), and PSA > 4 to < 10 ng/ml AS=70.6% vs Tx=57.2%. There were increasing trends of AS with recent years of diagnosis (AS rates of 13% vs T in 9.1% in 2021). For those who undergo Tx, Surgery occurred at 58.4% and was more common than radiation at 37%. Hormone therapy was recorded at 29.7%. Overall survival (OS) hazard ratio (HR) was 0.957 (0.925, 0.99; p=0.0117) after Inverse Probability Weighting (IPW) between AS vs Tx, Gleason score 6 vs >/=8 OS HR=0.206 (CI: 0.197,0.215; p <0.001) and treatment with radiation vs surgery OS HR=1.842 (CI: 1.686,2.011; p=<0.001). Overall, 149,172 men had stage IV prostate cancer diagnosis from 2010 to 2021, the incidence of stage IV disease numerically increased over time over the years from 6,832 patients in 2010 to 17,487 patients in 2021. Conclusions: Our analyses showed increasing trends of utilization of AS in prostate cancer patients with lower PSA, low Gleason score, academic/research settings, and urban settings, which are mostly guideline-concordant. Surgery was the most common modality for those who undergo treatment. There was an increasing incidence of stage IV diagnosis over time as well. Understanding these trends will help guide clinicians in appropriate adoption of active surveillance in practice settings.