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Trends in the treatment of localized prostate cancer using supplemented cancer registry data
Author(s) -
Hamilton Ann S.,
Albertsen Peter C.,
Johnson Terri Kang,
Hoffman Richard,
Morrell Donna,
Deapen Dennis,
Penson David F.
Publication year - 2011
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.2010.09514.x
Subject(s) - medicine , prostate cancer , watchful waiting , prostatectomy , brachytherapy , radiation therapy , cancer , localized disease , disease , multivariate analysis , univariate analysis , prostate specific antigen , oncology , gynecology , urology
Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Variation in treatment of localized prostate cancer has been shown to exist according to demographic and clinical factors, patient and provider preference, and region of residence since there is no consensus concerning appropriate treatment. Between 1998 and 2002 the proportion of men choosing watchful waiting declined from 12.6% to 9.0% while those receiving brachytherapy (with or without external beam radiation therapy) increased from 14.9% to 17.7%. Based on Gleason score, PSA, and age at diagnosis, younger African‐American men may be receiving less aggressive therapy than indicated, while older men with low risk tumours may be receiving more aggressive therapy than necessary. OBJECTIVE To conduct an analysis of localized prostate cancer treatment in the USA between 1998 and 2002. PATIENTS AND METHODS Results from the National Cancer Institute’s Patterns of Care study from 10 regional cancer registries in 1998 and 14 registries in 2002 were compared using univariate and multivariate statistical methods. RESULTS Patients with localized prostate cancer in 2002 were younger, had lower prostate‐specific antigen values, and higher Gleason scores compared with those diagnosed in 1998. Little change occurred in age‐adjusted percentages of men who were treated with a radical prostatectomy (45–46%) or by external beam radiation (EBRT) alone (19–20%). The proportion receiving brachytherapy (BT), alone or with EBRT, increased from 14.9 to 17.7%, while the proportion receiving watchful waiting declined from 12.6 to 9.0%. Younger African‐American men with intermediate/high‐risk disease were less likely to receive any type of aggressive therapy in comparison with Non‐Hispanic White men. Over 70% of men who were ≥75 years of age, with low‐risk disease, were treated with EBRT or BT. CONCLUSIONS Older men with low‐risk disease might be overtreated with aggressive therapy, while younger intermediate/high‐risk African‐American men appear less likely to receive indicated aggressive therapy.