Patterns of treatment of patients with prostate cancer initially managed with surveillance: Results from the CaPSURE database

Purpose: We determined the demographic and clinical profile of men who elec t surveillance as the initial management of prostate cancer as well as the incidence and predictors of secondary treatment of these patients. Materials and Methods: The Cancer of the Prostate Strategic Urological Rese arch Endeavor (CaPSURE) is a national disease registry of patients with var ious stages and treatments of prostate cancer. Using this database of 4,458 men we identified 329 (8.2%) who elected surveillance as the initial manag ement of prostate cancer. Patients choosing watchful waiting were compared to other CaPSURE participants using the chi-square test. The likelihood of treatment initiation in the watchful waiting group was calculated using the Kaplan-Meier method. After adjusting for patient age, race, prostate speci fic antigen (PSA) at diagnosis, clinical T stage and total Gleason score th e Cox proportional hazards regression model was used to determine significa nt predictors of treatment initiation. Results: Compared with others in the database, patients on watchful waiting were more likely to be 75 years old or older (51% versus 16%, p <0.001), w hite (93% versus 85%, p <0.001), and have lower serum PSA (p <0.001), organ confined disease (97% versus 88%, p <0.001) and a total Gleason score of 7 or less (97% versus 88%, p <0.001). In the watchful waiting group there wa s a 52% likelihood of treatment initiation within 5 years of the diagnosis. Significant predictors of secondary treatment were age younger than 65 yea rs and elevated serum PSA at diagnosis. Neither race, extraprostatic stage cT3 disease nor higher total Gleason score was a significant predictor of t reatment. Conclusions: Men who elect initial watchful waiting for prostate cancer ten d to be older, have lower serum PSA and more favorable disease characterist ics than those who seek treatment. PSA at diagnosis is the dominant factor for predicting secondary treatment.