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Trends and predictors of aggressive therapy for clinical locally advanced prostate carcinoma
Author(s) -
DENBERG THOMAS D.,
GLODÉ L. MICHAEL,
STEINER JOHN F.,
CRAWFORD E. DAVID,
HOFFMAN RICHARD M.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06260.x
Subject(s) - medicine , prostatectomy , prostate cancer , radiation therapy , epidemiology , surveillance, epidemiology, and end results , logistic regression , external beam radiotherapy , confidence interval , odds ratio , stage (stratigraphy) , surgery , cancer , cancer registry , paleontology , biology
OBJECTIVE To determine the patterns and predictors of aggressive local therapies for patients with clinically advanced (cT3) prostate carcinoma, as the USA National Cancer Institute considers external beam radiotherapy (EBRT) to be the most appropriate treatment for these patients, and currently there is less evidence supporting the use of radical prostatectomy (RP). PATIENTS AND METHODS We used the Surveillance, Epidemiology and End Results (SEER) cancer registries to identify patients diagnosed with cT3 disease between 1995 and 2001. Sociodemographic and clinical data included patient age, race/ethnicity, marital status, SEER registry, year of diagnosis, tumour stage and grade, and treatment. Multivariate logistic regression was used to identify significant predictors of receiving (i) RP vs EBRT, (ii) any aggressive local treatment (RP or EBRT) or no treatment. RESULTS Between 1995 and 2001, the proportion of men receiving aggressive local therapy for cT3 disease increased by 11% (58.4% to 69.4%), with a 20% increase in EBRT (40.3% to 60.2%) but a decline by half in RP (18.1% to 9.3%). Younger age was the strongest predictor of receiving RP rather than EBRT, and younger age with being married being a predictor of receiving aggressive local therapy (adjusted relative risk for marriage 1.33, 95% confidence interval 1.18–1.87). Black men were significantly less likely than non‐Hispanic white men to receive aggressive therapy, with a relative risk of 0.56 (0.45–0.69). CONCLUSION By 2001, 70% of patients with cT3 disease were receiving aggressive local therapy, with EBRT 6.5 times more common than RP. Clinical trials are needed to rigorously assess the effects of different local treatment strategies on clinical outcomes in men with cT3 prostate carcinoma.