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Prostate cancer mortality rates in low- and favorable intermediate-risk active surveillance patients: a population-based competing risks analysis

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Abstract

Purpose

To determine prostate cancer (PCa) and other-cause mortality rates in low- and favorable intermediate-risk (FIR) active surveillance (AS) patients.

Methods

The SEER Prostate with Watchful Waiting database was used to identify men diagnosed with NCCN low or FIR PCa, between 2010 and 2015, managed with AS. FIR patients were subdivided into three subgroups, based on their intermediate risk factor: grade group two (GG2), PSA 10–20 ng/ml or cT2b-c disease. Cumulative incidence function curves with other-cause mortality as the competing risk were utilized. Predictors of PCa mortality were assessed using multivariable regression analysis with semi-parametric proportional hazards modeling.

Results

Among 70,871 patients, 48,127 (67.9%) had low and 22,744 (32.1%) had FIR disease. Median patient age was 64.0 years, and median PSA was 5.70 ng/ml. Median follow-up was 49.0 months. There were 166 (0.2%) PCa and 3,176 (4.48%) other-cause mortalities. The 5-year mortality rates in the low and FIR cohorts overall were 0.29% and 0.28%, respectively (p = 0.64). Within the FIR cohort, the corresponding rates were highest in the PSA 10–20 ng/ml subgroup at 0.73%, followed by 0.32% for GG2 FIR and 0.052% for cT2b-c FIR disease (p < 0.001). Older age at diagnosis (sHR 2.38, p = 0.006), Medicaid insurance (sHR: 2.58, p < 0.001), low socioeconomic (sHR 1.39, p = 0.032), and non-married statuses (sHR: 2.58, p < 0.001) were associated with increased PCa mortality.

Conclusion

Intermediate-term PCa mortality rates in FIR PCa patients are non-significantly different to those with low-risk PCa. However, there is significant within-group heterogeneity, with PCa mortality rates significantly higher in the PSA 10–20 subgroup.

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Data availability

We have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Funding

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Author notes

  1. Christopher J. D. Wallis and Zachary Klaassen co-senior authors.

Authors and Affiliations

  1. Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Georgia Cancer Center, Augusta, GA, 30912, USA

    Rashid K. Sayyid, William C. Reed, Phillip Woodruff, Martha K. Terris & Zachary Klaassen

  2. Medical College of Georgia, Augusta, GA, USA

    John Z. Benton

  3. Georgia Cancer Center, Augusta, GA, USA

    Martha K. Terris & Zachary Klaassen

  4. Department of Urology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada

    Christopher J. D. Wallis

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  1. Rashid K. Sayyid
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  2. John Z. Benton
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  7. Zachary Klaassen
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Contributions

Sayyid was involved in the protocol/project development, data collection and management, data analysis, and manuscript writing. Benton, Reed, and Woodruff assisted in the protocol/project development, data collection and management, and manuscript revision. Terris, Wallis, and Klaassen contributed to the protocol/project development, data collection and management, manuscript revision, and supervision.

Corresponding author

Correspondence to Rashid K. Sayyid.

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Conflict of interest

The authors declare no relevant conflicts of interest.

Ethics approval

Given the deidentified and public availability of the dataset, research ethics board approval for this study was not required by the participating institutions.

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Moderated poster presentation at AUA 2022.

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Sayyid, R.K., Benton, J.Z., Reed, W.C. et al. Prostate cancer mortality rates in low- and favorable intermediate-risk active surveillance patients: a population-based competing risks analysis. World J Urol 41, 93–99 (2023). https://doi.org/10.1007/s00345-022-04228-4

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  • DOI: https://doi.org/10.1007/s00345-022-04228-4

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