The association of patient and disease characteristics with the overtreatment of low-risk prostate cancer from 2010 to 2016

ABSTRACT BACKGROUND Although active surveillance is the preferred management for low-risk prostate cancer (PCa), some men remain at risk of overtreatment with definitive local therapy. We

hypothesized that baseline characteristics may be associated with overtreatment and represent a potential source of health disparities. We therefore examined the associations of patient and

disease characteristics with the surgical overtreatment of low-risk PCa. METHODS We identified men aged 45–75 years with cT1 cN0 cM0 prostate adenocarcinoma with biopsy Gleason score 6 and

PSA < 10 ng/ml from 2010–2016 in the National Cancer Database (NCDB) and who underwent radical prostatectomy (RP). We evaluated the associations of baseline characteristics with

clinically insignificant PCa (iPCa) at RP (i.e., “overtreatment”), defined as organ-confined (i.e., pT2) Gleason 3 + 3 disease, using multivariable logistic regression. RESULTS We identified

36,088 men with low-risk PCa who underwent RP. The unadjusted rate of iPCa decreased during the study period, from 54.7% in 2010 to 40.0% in 2016. In multivariable analyses adjusting for

baseline characteristics, older age (OR 0.98, 95% CI 0.97–0.98), later year of diagnosis (OR 0.62, 95% CI 0.57–0.67 for 2016 vs. 2010), Black race (OR 0.85, 95% CI 0.79–0.91), treatment at

an academic/research program (OR 0.82, 95% CI 0.73–0.91), higher PSA (OR 0.91, 95% CI 0.90–0.92), and higher number of positive biopsy cores (OR 0.87, 95% CI 0.86–0.88) were independently

associated with a lower risk of overtreatment (iPCa) at RP. Conversely, a greater number of biopsy cores sampled (OR 1.01, 95% CI 1.01–1.02) was independently associated with an increased

risk of overtreatment (iPCa) at RP. CONCLUSIONS We observed an ~27% reduction in rates of overtreatment of men with low-risk PCa over the study period. Several patient, disease, and

structural characteristics are associated with detection of iPCa at RP and can inform the management of men with low-risk PCa to reduce potential overtreatment. Access through your

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BEING VIEWED BY OTHERS CHARACTERISTICS OF INCIDENTAL PROSTATE CANCER IN THE UNITED STATES Article 23 October 2023 TEMPORAL TRENDS IN THE NUMBER OF MEN ELECTING FOR CONSERVATIVE MANAGEMENT

FOR LOW-RISK PROSTATE CANCER IN THE UNITED STATES Article 13 July 2020 REVISITING CURRENT NATIONAL COMPREHENSIVE CANCER NETWORK (NCCN) HIGH-RISK PROSTATE CANCER STRATIFICATION: A NATIONAL

CANCER DATABASE ANALYSIS Article 14 January 2023 DATA AVAILABILITY The data that support the findings of this study are available from American College of Surgeons through a data request.

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in the US. JAMA Netw Open. 2023;6:e231439. Article  PubMed  PubMed Central  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Williams College, Williamstown,

MA, USA Cooper Desmond * Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA Sumedh Kaul & Aaron Fleishman * Division of Urologic Surgery, Beth Israel Deaconess

Medical Center, Boston, MA, USA Ruslan Korets, Peter Chang, Andrew Wagner, Aria F. Olumi & Boris Gershman * Division of Urology, University of Colorado Anschutz Medical Center, Aurora,

CO, USA Simon P. Kim * Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA Nima Aghdam Authors * Cooper Desmond View author publications You can also

search for this author inPubMed Google Scholar * Sumedh Kaul View author publications You can also search for this author inPubMed Google Scholar * Aaron Fleishman View author publications

You can also search for this author inPubMed Google Scholar * Ruslan Korets View author publications You can also search for this author inPubMed Google Scholar * Peter Chang View author

publications You can also search for this author inPubMed Google Scholar * Andrew Wagner View author publications You can also search for this author inPubMed Google Scholar * Simon P. Kim

View author publications You can also search for this author inPubMed Google Scholar * Nima Aghdam View author publications You can also search for this author inPubMed Google Scholar * Aria

F. Olumi View author publications You can also search for this author inPubMed Google Scholar * Boris Gershman View author publications You can also search for this author inPubMed Google

Scholar CONTRIBUTIONS Desmond: study conception/design, interpretation of statistical analyses, manuscript preparation/revision. Kaul: study conception/design, conducting statistical

analyses, manuscript preparation/revision. Fleishman: study conception/design, manuscript revision. Korets: study conception/design, manuscript revision. Chang: study conception/design,

manuscript revision. Wagner: study conception/design, manuscript revision. Kim: study conception/design, manuscript revision. Aghdam: study conception/design, manuscript revision. Olumi:

study conception/design, manuscript revision. Gershman: study conception/design, interpretation of statistical analyses, manuscript preparation/revision, supervision. CORRESPONDING AUTHOR

Correspondence to Boris Gershman. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. The National Cancer Data Base (NCDB) is a joint project of the

Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the

de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. ADDITIONAL

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permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Desmond, C., Kaul, S., Fleishman, A. _et al._ The association of patient and disease characteristics with the overtreatment of low-risk

prostate cancer from 2010 to 2016. _Prostate Cancer Prostatic Dis_ 28, 385–393 (2025). https://doi.org/10.1038/s41391-024-00822-2 Download citation * Received: 03 October 2023 * Revised: 05

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