Association of Socioeconomic Position, Prostate-specific Antigen, and Age with Observation in Low-risk Prostate Cancer Patients in Switzerland

TL;DR

Most low-risk prostate cancer patients in Switzerland choose observation over treatment, but younger men, those with lower socioeconomic status, and higher PSA levels are more likely to receive active treatment.

Contribution

The study identifies socioeconomic position, age, and PSA level as factors influencing treatment choices for low-risk prostate cancer in Switzerland.

Findings

65.4% of low-risk prostate cancer patients received observational management.

Lower socioeconomic position and younger age were associated with higher odds of active treatment.

Higher PSA levels were linked to a decreased likelihood of observational management.

Abstract

Most low-risk prostate cancer patients received observational management, but lower socioeconomic position, younger age, and a higher prostate-specific antigen level were associated with higher odds of active treatment. Further work is needed to understand the barriers to active surveillance uptake in low-risk prostate cancer patients.

Observation remains the recommended management approach for low-risk prostate cancer (PCa), aiming to balance oncological control and avoidance of overtreatment. This study investigated the use of observation and its association with patients’ socioeconomic position (SEP), age, and prostate-specific antigen (PSA) level on treatment choice in Switzerland.

This cohort study analyzed Gleason score 6 PCa diagnoses in 2020 and 2021 from the Swiss National Agency for Cancer Registration dataset. Variables included age, PSA value, residence, and treatment codes. Municipality-based SEP deciles were linked to patients. Multivariable regression assessed the associations between SEP and observational management.

Of 4296 men, 2876 (65.4%) received observational management, 792 (18.0%) underwent active treatment, and management was unknown in 728 (16.6%). Compared with men from low SEP areas, those from middle (odds ratio [OR] 1.11, 95% confidence interval [CI]: 0.92–1.35) and high SEP (OR 1.29, 95% CI: 1.06–1.58) areas had higher odds of observation. Men aged 60–70 yr (OR 1.53, 95% CI: 1.24–1.89) and >70 yr (OR 2.10, 95% CI: 1.68–2.62) were more likely to undergo observation than those aged <60 yr. PSA 5–10 ng/ml (OR 0.67, 95% CI: 0.55–0.82) and >10 ng/ml (OR 0.60, 95% CI: 0.46–0.78) were associated with lower odds of observation compared with PSA <5 ng/ml.

Most men diagnosed with localized low-risk PCa in Switzerland underwent observational management as the primary strategy in 2020 and 2021. However, at least 18% of men still received active treatment. Lower SEP, younger age, and higher PSA values were risk factors for active treatment within low-risk PCa patients.

We looked at how men in Switzerland with low-risk prostate cancer were treated in 2020 and 2021. We found that most men chose observation instead of immediate treatment, but men with lower socioeconomic position, younger age, or higher prostate-specific antigen levels were more likely to have active treatment. This suggests that there are opportunities to reduce unnecessary treatment for certain patient groups.

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