Prostate-specific antigen surveillance among men with clinically localized prostate cancer who do not receive initial treatment

Objective: To describe the use and determinants of prostate-specific antigen (PSA) surveillance in a population-based cohort. PSA measurements are an important component of surveillance for men with clinically localized prostate cancer who do not receive initial treatment. Methods: Using the linked Surveillance, Epidemiology, and End Results-Medicare program, we evaluated 7145 men, aged 65-84 years, who had been diagnosed from 1997 to 2002 with American Joint Committee on Cancer, 6th edition, Stage T1-T2, Gleason score ≤7 prostate cancer and received expectant management. For all patients, the Medicare claims were observed until a secondary cancer treatment event, death, or December 31, 2006. We performed multivariable logistic regression analysis to examine the relationship between the primary outcome of annual PSA surveillance and the patient, clinical, and demographic characteristics. Results: Of the men with localized Gleason score ≤7 prostate cancer who did not receive initial treatment, 39% underwent at least annual PSA measurement. On multivariable logistic regression analysis, annual PSA surveillance was positively associated with older age (75-84 vs 65-74 years, odds ratio [OR] 1.37, 95% confidence interval [CI] 1.23-1.52), more comorbidities (OR 3.38, 95% CI 2.91-3.93), and residence in a neighborhood with a greater median income (OR 1.81, 95% CI 1.46-2.25). A lower likelihood of annual PSA surveillance was associated with black race (OR 0.55, 95% CI 0.45-0.67). Conclusion: Most men with localized prostate cancer who forgo initial treatment do not receive annual PSA surveillance. Additional research is necessary to clarify the benefits and harm of increased surveillance among older men and those with medical comorbidities.