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The Use And Effect Of Expectant Management In Prostate Cancer
Expectant Management is Underutilized Across Variety of Practice Settings; Adoption May be Tied to Reimbursement

San Diego, CA, May 5,2013 – A new study reveals the use of expectant management (EM) as a treatment course for prostate cancer did not increase in the last decade. The study population included patients with low-risk (stage 1) prostate cancer or who were aged 70 and older. However EM use, which involves active surveillance (AS) or watchful waiting, in prostate cancer patients treated at Veterans Affairs (VA) hospital settings increased more than ten percent within the same timeframe.

Additionally, a separate study which looked at men in the United Kingdom (UK) on AS for prostate cancer reveals they are depressed and anxious at significantly higher rates than the general population and may choose radical treatment without signs of disease progression. Both studies, which examine the use and effect of EM, a strategy to minimize prostate cancer overtreatment, will be presented at the 108th Annual Scientific Meeting of the American Urological Association (AUA) during a joint press conference at the San Diego Convention Center, San Diego, CA on May 5 at 1:00 p.m. PDT.

”While data supporting EM as a management option for men with low-risk prostate cancer has matured, rates of EM have not correspondingly increased,” said Scott Eggener, MD, Associate Professor, Urologic Oncology, University of Chicago.  “The VA system appears to have led the way in adoption of EM, suggesting factors such as patient population, practice setting or even reimbursement models may play a critical role in the decision on whether or not to use EM. Additionally, studies on the use of EM clearly demonstrate a growing need to support the psychological needs of patients, particularly those who are single.”

Study Details

Persistent Underutilization of Expectant Management for Prostate Cancer Last Decade in The United States (#1149): Researchers from Louis Stokes Cleveland VA Medical Center in Cleveland, OH queried the National Cancer Database (NCDB) for the years 2000-2009 to identify prostate cancers managed with EM. They then examined EM usage by cancer-risk group, age group, number of co-morbidities and practice setting.

Results showed:

  • Overall use of EM remained stable at 7.5-9.8 percent from 2000 to 2009 with a similar trend across stage 1 cancer patients and those ≥70.
  • VA hospitals had a significantly higher and increasing EM rate (19.7 percent to 30.8 percent from 2000 to 2009), as compared to other practice settings (comprehensive cancer centers, community hospitals and teaching hospitals), which showed no trend of increased adoption.
  • Further analysis of the VA system showed increased EM use for those with stage 1 cancer (53.7 percent), aged ≥70 years (27.9 percent) and living with ≥2 co-morbidities (26.9 percent), a pattern not shared by other practice settings.

Investigators concluded the use of EM did not increase overall or in third party payer practice settings during the last decade. However, increased use in the VA setting indicates reimbursement may play an important role in the adoption of EM, a possibility warranting further exploration.

Depression and Anxiety in Men on Active Surveillance for Prostate Cancer (#6577): Researchers from the University of Southampton and University College London, both in the UK, examined the incidence of clinical depression and anxiety in 338 AS patients from multiple sites in the UK and assessed demographic variables predictive of psychological distress. Study participants completed the Hospital Anxiety and Depression Scale (HADS) and a demographic questionnaire.

 Results showed:

  • The mean depression and anxiety scores were 3.31 (SD=3.569) and 4.63 (SD=3.791), respectively.
  • Nearly 15 percent of cases met the HADS criteria (score 8) for clinically significant depression and a little over 22 percent for anxiety. For comparison, the incidence of clinical depression and anxiety in the general population of men >65 in the UK is six percent and eight percent, respectively.
  • Relationship status was a significant predictor of anxiety (p=0.05) with single men presenting with an anxiety score 2.852 higher than men in a relationship.

Investigators concluded men on AS are nearly twice as likely to be depressed and more than three times as likely to be anxious compared to the general population of men >65 in the UK. This suggests a need to identify and manage the psychological needs of men on AS, particularly those who are single. Researchers plan to undertake a future study to pilot new ways of supporting men on AS. 

 NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange an interview with an expert, please contact the AUA Communications Office at the number above or e-mail

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 19,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.

Christine Frey, AUA