National trends in the management of low-risk prostate cancer: analyzing the impact of Medicaid expansion in the United
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UROLOGY - ORIGINAL PAPER
National trends in the management of low‑risk prostate cancer: analyzing the impact of Medicaid expansion in the United States Juan Chipollini1 · Grant R. Pollock1 Received: 6 February 2020 / Accepted: 4 April 2020 © Springer Nature B.V. 2020
Abstract Purpose To evaluate recent trends in the management of low-risk prostate cancer (PCa) and analyze differences in adoption of surveillance based on state Medicaid-expansion status in the United States (US). Methods Using the National Cancer Database, we identified men diagnosed from 2012 to 2016. Men with histologically confirmed low-risk PCa defined as PSA less than 10 ng/ml, Gleason score ≤ 6, and cT1–T2a were included. The Cochran Armitage test was used to evaluate trends in surveillance versus treatment. Comparisons on surveillance adoption based on 2014 Medicaid expansion status and difference-in-difference analysis were performed. Results The cohort included 84,340 men. During the study period, surveillance as initial management increased from 13.6% in 2012 to 32.1% in 2016 (p
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