Patient-level factors associated with the use of active surveillance: The talking about prostate cancer cohort.
Authors: Mukand Nita , Shariff-Marco Salma , Brooks James D. , Chung Benjamin I. , Leppert John T. , Frosh Dominick , Sieh Weiva , Guan Alice , Santiago-Rodriguez Eduardo J , Carroll Peter , Shim Janet K , Kuo Mei-Chin , Allen Laura , DeRouen Mindy , Cheng Iona , Gomez Scarlett L. , Lu Qian 
Published: June 2023

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Background: Talking About Prostate Cancer is a population-based cohort study on multilevel determinants of active surveillance (AS) and patient reported outcomes in a racially and ethnically diverse population of men with low-risk prostate cancer. The study includes qualitative one-on-one interviews with patients and physicians, and quantitative cross-sectional provider and longitudinal (baseline and 12-month follow-up) patient surveys to address gaps in the literature regarding patient-level factors associated with AS, particularly among understudied populations including Asian American and Hispanic patients, we assessed socio-demographic characteristics associated with receipt of AS. Methods: Men aged 40-79 diagnosed with low-risk prostate cancer from May 2018 through March 2022 were identified within 12 months of diagnosis from the population-based Greater Bay Area Cancer Registry. To expand recruitment, men were also identified from the cancer registries covering the rest of California. To ensure sufficient representation of diverse racial and ethnic groups, 20% of non-Hispanic White men were sampled, while all Asian American and Pacific Islander, Black, and Hispanic men were invited to participate. Univariable and multivariable logistic regression were used to estimate the odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (CI), of receiving AS. Potential predictors included year of diagnosis, age, health insurance, usual source of care, race and ethnicity, educational attainment, employment, nativity, and language preference. Results: Among 500 men with low-risk prostate cancer, 27% went on AS, 30% underwent surgery, radiation, hormonal treatment, cryotherapy, and/or high-intensity focused ultrasound, and 43% had not yet made a treatment decision at baseline. Among those who had made a treatment decision at baseline (N = 287), 27% of Hispanic men received AS, which was the lowest proportion among the racial and ethnic groups (Black 28%; Asian 47%; White 59%). A higher proportion of coupled men (29%) received AS compared to single men (15%). Less than half of men with less than a high school education received AS. Compared to men with a high school education or less, men with a bachelor’s degree had an aOR of 2.91 (95% CI 1.10 – 8.42) and men with a graduate degree had an aOR of 4.37 (95% CI 1.50-12.76) of receiving AS. A significantly lower odds of AS was identified among Black (aOR 0.26; 95% CI 0.11-0.64) and Hispanic men (aOR 0.35; 95% CI 0.15 – 0.81) compared to non-Hispanic White men. Conclusions: We identified several significant socio-demographic differences between patients who received definitive treatment versus AS in this cohort, including race and ethnicity and educational attainment. Further study of these domains in larger, diverse samples will elucidate the strength of these associations within racial and ethnic groups.