Table 5.
Factors associated with the discontinuation of active surveillance within 5 years of diagnosis
| Variables | Univariable HR (95% CI) |
p | Multivariable† HR (95% CI) |
p |
|---|---|---|---|---|
| Patient-specific characteristics | ||||
| Age, per 10 years increase | 0.63 (0.55–0.74) | <0.001 | 0.60 (0.51–0.71) | <0.001 |
| Year of diagnosis | ||||
| 2002–04 | REF | REF | ||
| 2005–07 | 0.76 (0.55–1.04) | 0.09 | 1.43 (1.00–2.05) | 0.049 |
| 2008–11 | 0.84 (0.59–1.20) | 0.4 | 1.79 (1.18–2.72) | 0.006 |
| ADG scores, per 1-unit increase | 0.99 (0.98–1.00) | 0.11 | ||
| Area of residency (rural vs. urban) | 1.31 (0.86–1.96) | 0.19 | ||
| Neighborhood Income quintile | ||||
| 1st quintile | REF | |||
| 2nd quintile | 1.33 (0.85–2.09) | 0.2 | ||
| 3rd quintile | 1.34 (0.85–2.10) | 0.2 | ||
| 4th quintile | 1.19 (0.77–1.83) | 0.4 | ||
| 5th quintile | 1.35 (0.90–2.04) | 0.15 | ||
| Disease characteristics at diagnosis | ||||
| PSA category at diagnosis (ng/mL) | ||||
| 0–4 | REF | |||
| 4.01–10 | 1.35 (0.74–2.46) | 0.3 | ||
| >10 | 1.77 (0.91–3.41) | 0.09 | ||
| Missing | 1.29 (0.71–2.35) | 0.4 | ||
| Number of positive cores at diagnosis | ||||
| 1 | REF | |||
| 2 | 1.02 (0.65–1.57) | 0.9 | ||
| 3 | 1.44 (0.93–2.23) | 0.10 | ||
| >3 | 1.44 (0.99–2.09) | 0.06 | ||
| Missing | 1.19 (0.74–1.93) | 0.5 | ||
| Max. % of core involvement at diagnostic (>50% vs. ≤50%) | 1.19 (0.82–1.73) | 0.4 | 0.79 (0.54–1.18) | 0.3 |
| Gleason grade group at diagnosis (3 vs. 2) | 1.22 (0.92–1.63) | 0.16 | 1.33 (0.98–1.82) | 0.06 |
| Disease characteristics at confirmatory biopsy | ||||
| Gleason grade group at confirmatory | ||||
| 2 or 3 | REF | REF | ||
| 4 or 5 (upgraded) | 1.08 (0.60–1.93) | 0.8 | 1.30 (0.70–2.42) | 0.4 |
| 1 (downgraded) | 0.55 (0.39–0.80) | 0.002 | 0.61 (0.44–0.99) | 0.02 |
| Negative | 0.37 (0.21–0.66) | <0.001 | 0.33 (0.18–0.61) | <0.001 |
| Number of positive cores at confirmatory | ||||
| 1 | REF | REF | ||
| 2 | 1.23 (0.67–2.38) | 0.5 | 1.03 (0.52–2.02) | 0.9 |
| 3 | 1.84 (1.02–3.31) | 0.04 | 2.06 (1.08–3.09) | 0.03 |
| 3+ | 1.76 (1.04–2.96) | 0.03 | 1.56 (0.86–2.82) | 0.14 |
| Missing | 1.99 (1.19–3.35) | 0.009 | 2.59 (1.40–4.78) | 0.002 |
| Max. % of core involvement at confirmatory biopsy (>50% vs. ≤50%) | 1.14 (0.84–1.55) | 0.4 | ||
| Prostate cancer treatment-specific characteristics | ||||
| Primary physician (urologist vs. radiation oncologist | 0.41 (0.31–0.56) | <0.001 | 0.43 (0.29–0.61) | <0.001 |
| Physician annual prostate cancer treatment volume | ||||
| 1st tertile (lowest) | REF | |||
| 2nd tertile | 1.28 (0.75–1.86) | 0.5 | ||
| 3rd tertile (highest) | 1.31 (0.87–1.99) | 0.19 | ||
| Specialized cancer-center (yes vs. no) | 1.59 (1.23–2.05) | <0.001 | 1.35 (1.00–1.82) | 0.048 |
| Institution annual prostate cancer treatment volume | ||||
| 1st tertile (lowest) | REF | |||
| 2nd tertile | 1.10 (0.63–1.93) | 0.7 | ||
| 3rd tertile (highest) | 1.20 (0.72–2.01) | 0.5 | ||
†
Variables significant in univariate model were selected for multivariable model, and a stepwise selection approach was used for the final multivariate model. ADG: aggregated diagnosis group; CI: confidence interval; HR: hazard ratio; PSA: prostate specific antigen.