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Increase in Conservative Management of Veterans with Low-Risk Prostate Cancer Suggests Reduction in Over-Treatment


BACKGROUND:
Low-risk prostate cancer has a favorable prognosis without treatment. Current guidelines recommend conservative management or deferring upfront treatment as the preferred approach, but previous studies reported under-utilization in the United States, compared with other countries. Thus, investigators assessed utilization of conservative management among Veterans by examining treatment patterns for Veterans diagnosed with low-risk prostate cancer (n=125,083) from 1/05 through 11/15, with follow up through 11/17. Untreated Veterans were classified as receiving conservative management through either active surveillance (> 2 PSAs and 1 biopsy within 2 years after diagnosis) or watchful waiting.

FINDINGS:

  • Utilization of conservative management increased among both men younger than 65 years (27% in 2005 to 72% in 2015) and those 65 or older (35% in 2005 to 79% in 2015). The increase was primarily due to greater use of active surveillance.
  • Among Veterans diagnosed with low-risk prostate cancer, 52% (n=65,142) were treated and 48% (n=59,941) received conservative management.
  • Of those who received conservative management, 30% (n=37,717) received watchful waiting and 18% (n=22,224) received active surveillance.

IMPLICATIONS
Utilization of conservative management has increased significantly among Veterans with low-risk prostate cancer, suggesting a substantial reduction in over-treatment during the past decade.

LIMITATIONS:

  • There may have been misclassification or non-detection of treatment received outside VA.
  • Investigators had difficulty distinguishing active surveillance vs. watchful waiting using adminstrative codes.

AUTHOR/FUNDING INFORMATION:
This study was partly supported by an HSR&D Career Development Award to Dr. Makarov, who is part of the Manhattan VA Medical Center in New York.


PubMed Logo Loeb S, Byrne N, Makarov D, Lepor H, Walter D. Use of Conservative Management for Low-Risk Prostate Cancer in the Veterans Affairs Integrated Health Care System from 2005-2015. Research Letter. JAMA. June 5, 2018;319(21):2231-2233.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.