Current guidelines recommend conservative management as the preferred option for most low-risk prostate cancer cases, with certain possible exceptions (age <55yr, African Americans, and high-volume grade group 1). Although previous studies have documented substantial heterogeneity in the uptake of conservative management, less is known about the underlying reason for this variation and whether it is due to guideline-concordant factors (age, race, and biopsy cancer volume). We explored variation in the use of conservative management for low-risk prostate cancer among 20 597 men diagnosed in the US Veterans Affairs health care system from 2010 to 2016. Conservative management increased substantially over this time from 51% to 76% (p< 0.001). However, there was substantial variation by facility (35-100%). Multivariable analysis revealed that patient factors included in the guidelines (e.g., age and biopsy cores), other patient factors (eg, marital status and PSA) and non-patient factors (eg, geographic region, case volume, year) were associated with conservative management use. In conclusion, even within an integrated health care system, there remains significant heterogeneity in the uptake of conservative management for low-risk prostate cancer. Both guideline-concordant factors and other factors not discussed in the guidelines were associated with conservative management use. PATIENT SUMMARY: In the US Veterans Affairs health care system the vast majority of men with low-risk prostate cancer were managed conservatively by 2016, although there was significant variation by facility. Patient factors specifically mentioned in guidelines had the greatest impact on prediction of conservative management.

中文翻译：

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探索退伍军人事务医疗系统中低风险前列腺癌的保守治疗使用的变化。

当前的指南建议保守治疗是大多数低风险前列腺癌病例的首选选择，但可能存在某些例外情况（年龄<55岁，非裔美国人和高等级人群1）。尽管先前的研究已经证明在采用保守治疗方面存在很大的异质性，但对于这种变异的根本原因以及是否是由于指南一致的因素（年龄，种族和活检癌体积）所知甚少。我们研究了2010年至2016年在美国退伍军人事务卫生保健系统中诊断出的20597名男性中，低危前列腺癌使用保守治疗的差异。在此期间，保守治疗的比例从51％大幅提高至76％（p <0.001） ）。但是，设施差异很大（35-100％）。多变量分析显示，指南中包括的患者因素（例如年龄和活检核心），其他患者因素（例如婚姻状况和PSA）和非患者因素（例如地理区域，病例数量，年份）与保守因素相关管理使用。总之，即使在一个综合的医疗保健系统中，对低危前列腺癌的保守治疗的采用仍然存在很大的异质性。准则一致因素和准则中未讨论的其他因素均与保守的管理使用有关。患者总结：在美国退伍军人事务卫生保健系统中，到2016年，绝大多数低危前列腺癌男性患者接受了保守治疗，尽管各机构之间存在显着差异。