Use and Predictors of Expectant Management of Low and Intermediate Risk Localized Prostate Cancer in Elderly Men

AbstractIntroduction: Expectant management reduces overtreatment in low risk but not intermediate risk localized prostate cancer. We assessed the use and predictors of expectant management to understand its uptake in practice in the United States.Methods: Using the SEER (Surveillance, Epidemiology and End Results)-Medicare database, we conducted a retrospective cohort study of men 66 years or older diagnosed with low (25,506 patients) or intermediate risk (25,597) localized prostate cancer between 2004 and 2011 and followed through December 31, 2012. We defined expectant management as 1) no definitive therapy and at least 1 prostate specific antigen test or repeat biopsy 4 to 12 months after diagnosis or 2) receiving definitive therapy after prostate specific antigen testing or repeat biopsy 7 to 12 months after diagnosis. We performed separate analyses for low and intermediate risk groups using multiple logistic regressions.Results: For men diagnosed with prostate cancer in 2004 to 2011 expectant managem...