Trends in the use of active surveillance and treatments in Medicare beneficiaries diagnosed with localized prostate cancer

Background: The treatment for men diagnosed with localized prostate cancer has changed over time given the increased attention to the harms associated with over-diagnosis and the development of protocols for active surveillance. Methods: We examined trends in the treatment of men diagnosed with localized prostate cancer between 2004 and 2015, using the most recently available data from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare. Patients were stratified by Gleason score, age, and race groups. Results: The use of active surveillance increased from 22% in 2004-2005 to 50% in 2014-2015 for patients with a Gleason score of 6 or below and increased from 9% in 2004-2005 to 13% in 2014-2015 for patients with a Gleason score of 7 or above. Patients with a Gleason score of 7 or above had increased use of intensity-modulated radiation therapy and prostatectomy, especially among patients aged 75 years and older. Among patients with a Gleason score of 6 or below non-Hispanic black men were less likely to undergo active surveillance than non-Hispanic white men. Conclusions: There has been a large increase in the use of active surveillance among men with a Gleason score of 6 or below. However, non-Hispanic black men with a Gleason score of 6 or below are less likely to receive active surveillance. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

The study found a significant increase in the use of active surveillance among men diagnosed with localized prostate cancer and a lower likelihood of non-Hispanic black men with a Gleason score of 6 or below to receive active surveillance. Patients with a Gleason score of 7 or above tended to undergo intensity-modulated radiation therapy or prostatectomy, especially among those aged 75 years and older.