Watchful Waiting Active Surveillance in Prostate Cancer Patients – a Population-Based Study Using the SEER-Medicare Linked Database

Prostate cancer is the most common cancer diagnosis and the second most common cancer-related death among men living in the United States. The increase in incident prostate cancer diagnosis was attributed partially to the widespread use of prostate cancer screening. African American men have higher risk of prostate cancer and cancer related mortality. In patients diagnosed with early and localized tumors, the risk of cancer specific mortality is low. Elderly men with early and localized tumors are less likely to die from prostate cancer. Various treatment options are available, but each has its own set of complications. Therefore, the dissertation study examined whether a less aggressive treatment strategy, watchful waiting active surveillance (WWAS), had any survival benefits in elderly patients. The dissertation study had three main goals. The first goal addressed two methodological issues on how treatment modalities should be captured and how WWAS should be defined. The second goal examined the effect of WWAS on survival outcomes in elderly patients over the age of 75 years. The third goal explored whether survival disparities between African American and Caucasian could be explained. The dissertation study was a population-based study using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The study recommends that treatment modalities can be defined at 2 years following diagnosis. The survival benefits observed in the WWAS group relative to the No Treatment group imply that any future comparison of various treatment options needs to distinguish between those who do and do not undergo active surveillance. The study also found that in men over age 75 with early localized disease; WWAS had a much lower risk of cancer specific mortality and comparable overall survival as compared to aggressive treatment. The study results support watchful waiting with active surveillance as a desirable treatment option for older men with early and localized prostate cancer. Finally, the study found that African American prostate cancer patients continued to have greater risks of prostate cancer specific and overall mortality. The study findings suggest the importance of evaluating other non-clinical characteristics such as diet and environments, as additional ways to eliminate survival disparities.