Urologists have been criticized for over-treating men with low-risk prostate cancer, and for passively observing older men with higher-risk disease. Proponents of active surveillance (AS) for low-risk disease and critics of watchful waiting (WW) for higher-risk disease have advocated for more judicious use of observation. Thus, we compared two population-based cohorts to determine how expectant management has evolved over the past two decades.
5,871 men with localized prostate cancer were enrolled in the Prostate Cancer Outcomes Study (PCOS: 1994 to 1995) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR: 2011 to 2012) study. We compared use of definitive treatment vs. expectant management (WW/AS) across cohorts, focusing on the influence of disease risk, age and comorbidities.
Use of WW/AS was similar in PCOS and CEASAR (14% in each). Compared to PCOS, more men in CEASAR with low-risk disease selected WW/AS (25% vs. 15%, respectively), whereas fewer men with intermediate- (7% vs. 14%) and high-risk (3% vs. 10%) disease chose WW/AS (p<0.001 for each). The association of disease risk with WW/AS was significantly larger in CEASAR than PCOS (OR, 7.3; 95% confidence interval [CI], 3.4 to 15.7). Older age was associated with WW/AS in both cohorts, but there was no association between comorbidity and WW/AS in CEASAR.
Use of WW/AS was more aligned with disease risk in CEASAR compared PCOS, suggesting there has been a pivot from WW to AS. While older men were more likely to be observed, comorbidity had little, if any, influence.
This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 March 2017.
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#9,269,368
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Outputs from The Journal of Urology
#6,917
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#98,004
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Outputs of similar age from The Journal of Urology
#79
of 357 outputs
Altmetric has tracked 34,350,842 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 21,939 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.7. This one has gotten more attention than average, scoring higher than 68% of its peers.
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