Mp23-06 racial Disparities in Years of Potential Life Lost Secondary to Untreated Low and Intermediate Risk Prostate Cancer Deaths

Abstract

surgery or radiotherapy amongst those patients with low volume, low grade prostate cancer. Expansion upon PRIAS criteria defining the appropriate active surveillance population has become commonplace. This change in thinking has ensued as large prospective randomized trials such as PROTECT mature, with 10 year follow up suggesting there is no overall mortality benefit to aggressive therapy versus active surveillance. We sought to ascertain whether those men who fail active surveillance have worse oncologic outcomes than matched peers undergoing immediate radical prostatectomy.METHODS: An audit was undertaken of a prospectively collected database capturing patients with prostate cancer identified by transperineal biopsy between January 2012 and December 2017. Patients were divided into those initially managed by active surveillance vs those with who were treated with surgery primarily. Histologic and oncologic outcomes were compared for time and disease burden matched populations of men with low and low-intermediate risk prostate cancer defined as ISUP 1 and 2 (Gleason pattern 4 component <10%) low volume disease respectively. 128 patients over the 5 year period were captured, where 88 were initially placed on active surveillance, and 40 elected to proceed to radical prostatectomy without a preliminary period of Active Surveillance.RESULTS: Mean patient age was 60.6 vs 61 years in the active surveillance and immediate surgery groups, mean PSA at diagnosis was 5.2 vs 5.6 respectively, and pre biopsy MRI was performed in 71% vs 73% of the AS vs immediate surgery groups. Surgical specimens had a gland volume of 52ml vs 50 ml. 71% of patients had one or more MRI scans during their period of active surveillance. Pathological stage of pT3a was 45% vs 32%, 21% vs 0% had pathological upgrading of Gleason score and 25% vs 17.5% had involved margins in the AS vs immediate treatment groups. Biochemical recurrence with a minimum of 18 months of follow up has been 13% in the AS group vs 0% in the immediate treatment groups. Mean time on active surveillance to failure was 29.1 months.CONCLUSIONS: Those men who fail AS appear to have worse outcomes compared to matched peers undergoing immediate radical prostatectomy. These results are possibly reflective of an increasing trend to put patients on active surveillance who do not meet the strict PRIAS criteria for active surveillance in an effort to delay or avoid potential side effects of treatment of their prostate cancer.

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

“…We perform the modified Xu et al MC simulation procedure described in Section 2.6 for iterations using a constant YPLL upper reference age of years for all racial/ethnic groups considered, an approach used by the Centers for Disease Control and Prevention (CDC) [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] and in other applied research domains [ 64 , 65 ], obtaining conservative 95% interval estimates of total YPLL, percentage of total YPLL, and age-adjusted YPLL rates by race/ethnicity as well as age-adjusted YPLL RR’s for NH Blacks, Hispanics, NH Asians, and NH AIAN’s relative to NH Whites in each of the 46 examined states. An alternative approach that has been employed in applied studies contrasting YPLL by race/ethnicity is to use race/ethnicity-specific YPLL upper reference ages corresponding to the respective life expectancies [ 36 , 37 , 66 , 67 , 68 , 69 ], thereby reflecting known heterogeneity in underlying life expectancies between racial/ethnic groups.…”

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

“…We perform the modified Xu et al MC simulation procedure described in Section 2.6 for B = 1000 iterations using a constant YPLL upper reference age of A = 75 years for all racial/ethnic groups considered, an approach used by the Centers for Disease Control and Prevention (CDC) [49][50][51][52][53][54][55][56] and in other applied research domains [57,58], obtaining conservative 95% interval estimates of total YPLL, percentage of total YPLL, and age-adjusted YPLL rates by race/ethnicity as well as age-adjusted YPLL RR's for NH Blacks, Hispanics, NH Asians, and NH AIAN's relative to NH Whites in each of the 46 examined states. An approach that has been employed in applied studies contrasting YPLL by race/ethnicity is to use race/ethnicity-specific YPLL upper reference ages corresponding to the respective life expectancies [28,29,[59][60][61][62], thereby reflecting known heterogeneity in underlying life expectancies between racial/ethnic groups.…”