Evidence map›Paper›PMID 32777369›Full record

ArticleUrology2020

Overtreatment and Underutilization of Watchful Waiting in Men With Limited Life Expectancy: An Analysis of the Michigan Urological Surgery Improvement Collaborative Registry.

Udit Singhal, Jeffrey J Tosoian, Ji Qi, David C Miller, Susan M Linsell, Michael Cher, Brian Lane, Michael Cotant, James E Montie, Wassim Bazzi and 4 more

Abstract read
PubMed Publisher
In one paragraph

Article in Urology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.6field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 1 country.

Udit SinghalDepartment of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI. Electronic address: usinghal@med.umich.edu.
Jeffrey J TosoianDepartment of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI.
Ji QiDepartment of Urology, University of Michigan, Ann Arbor, MI.
David C MillerDepartment of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI.
Susan M LinsellDepartment of Urology, University of Michigan, Ann Arbor, MI.
Michael CherDepartment of Urology, Karmanos Cancer Center, Wayne State University, Detroit, MI.
Brian LaneDepartment of Urology, Spectrum Health, Grand Rapids, MI.
Michael CotantWar Memorial Hospital, Sault Ste. Marie, MI.
James E MontieDepartment of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI.
Wassim BazziMichigan Institute of Urology, Troy, MI.
Mohammad JafriDepartment of Urology, Comprehensive Medical Center, Royal Oak, MI.
Bradley RosenbergDepartment of Urology, Comprehensive Medical Center, Royal Oak, MI.
Arvin K GeorgeDepartment of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI.
Michigan Urological Surgery Improvement Collaborative
University of Michigan–Ann Arbor · USComprehensive Urology · USMemorial Hospital · USMichigan Institute of Urology · USSpectrum Health · USWayne State University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine rates of watchful waiting (WW) vs treatment in prostate cancer (PCa) and limited life expectancy (LE) and assess determinants of management. MATERIALS AND

methodsPatients diagnosed with PCa between 2012 and 2018 with <10 years LE were identified from the Michigan Urologic Surgery Improvement Collaborative registry. Multinomial logistic regression models were used to identify factors associated with management choice among NCCN low-risk PCa patients. Data from high-volume practices were analyzed to understand practice variation.

resultsTotal 2393 patients were included. Overall, WW was performed in 8.1% compared to 23.3%, 25%, 11.2%, and 3.6% who underwent AS, radiation (XRT), prostatectomy (RP), and brachytherapy (BT), respectively. In men with NCCN low-risk disease (n = 358), WW was performed in 15.1%, compared to AS (69.3%), XRT (4.2%), RP (6.7%), and BT (2.5%). There was wide variation in management among practices in low-risk men; WW (6%-35%), AS (44%-81%), and definitive treatment (0%-30%). Older age was associated with less likelihood of undergoing AS vs WW (odds ratio [OR] 0.88, P < .001) or treatment vs WW (OR 0.83, P < .0001). Presence of ≥cT2 disease (OR 8.55, P = .014) and greater number of positive biopsy cores (OR 1.41, P = .014) was associated with greater likelihood of treatment vs WW and Charlson comorbidity score of 1 vs 0 (OR 0.23, P = .043) was associated with less likelihood of treatment vs WW.

conclusionWide practice level variation exists in management for patients with low- and favorable-risk PCa and <10-year LE. Utilization of WW is poor, suggesting overtreatment in men who will experience little benefit.

Indexed as

Life ExpectancyAgedAged, 80 and overAge FactorsComorbidityHumansMaleMichiganOvertreatmentPractice Patterns, Physicians'Prostatic NeoplasmsRegistriesWatchful Waiting

Identifiers

PMID32777369
OpenAlexW2941102776

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.