A retrospective analysis of hospital trends has shown that the likelihood of receiving expectant management for low-risk prostate cancer was significantly lower in men evaluated at community centers compared with academic centers.
The study, which was published in Urology and led by Nataniel H Lester-Coll, MD, Yale School of Medicine (New Haven, CT), examined factors associated with expectant management of men with low-risk prostate cancer, which consists of active surveillance or observation of disease and is increasingly being considered as the standard of care given the morbidity and lack of survival benefit associated with definitive treatment for low-risk prostate cancer.
Researchers looked at patient records in the National Cancer Data Base from 2010-1013. Men with low-risk prostate cancer were grouped based on which management strategies were used to treat their disease: expectant management, or definitive treatment. A regression model was used to determine the association between management strategy and facility type (community vs academic).
A total of 91,556 men were included in the analysis, 52,417 (57%) were evaluated at community centers and 39,139 (43%) were evaluated at academic centers. Overall, only 12% of men included in the study were managed expectantly while 88% went on to receive surgery or radiation. However, researchers also found that those evaluated at academic centers were significantly more likely to receive expectant management than those at community centers (17% vs 8%). Statistical analysis confirmed that evaluation at an academic versus community facility was independently associated with increased odds of expectant management utilization.
Thus, researchers concluded that patients treated at academic centers for low-risk prostate cancer were more likely to receive expectant management than those treated at community centers. Further investigation as to what factor cause this variation and the influence of expectant management are warranted.
