Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high‐risk prostate cancer

Abstract

We aimed to determine patterns in frequency of radiotherapy for prostate cancer and definitive surgical management. There is prospective evidence indicating benefits of radiotherapy for some patients after radical prostatectomy (prostatectomy), with recent evidence suggesting benefit of early salvage radiotherapy. Trends in postoperative radiotherapy have not been elucidated. We analyzed the National Cancer Database for prostate cancer patients treated with curative‐intent therapy between 2004 and 2016. Patients were risk stratified according to NCCN treatment guidelines. Linear regression was utilized to examine trends in treatment with initial prostatectomy and trends in postoperative radiotherapy among treatment risk groups. Multivariable logistic regression was utilized to examine clinical‐demographic variables associated with prostatectomy and postoperative radiotherapy. From 2004 to 2016, 508,450 patients received prostatectomy and 370,314 received radiotherapy. Median age was 63.6 years. There was increased utilization of prostatectomy from 47.9% in 2004 to 61.3% in 2016 (p trend <0.001). 24,466 cases received postoperative radiotherapy. Similarly, postoperative radiotherapy utilization increased from 2.2% in 2004 to 4.0% in 2016 (p trend <0.001). The subgroup with the largest increase in postoperative radiotherapy was clinically high‐risk disease (5.3% in 2004 to 7.8% in 2016 (p trend <0.001). Clinical high‐risk disease (OR 1.751), Gleason 9‐10 (OR 2.973), and PSA >20 ng/ml (OR 1.489) were factors predictive for postoperative radiotherapy. The proportion of prostate cancer patients who undergo definitive prostatectomy and postoperative radiotherapy is increasing. This increase is greatest in high‐risk cases. Overall, the proportion of patients who receive any radiotherapy is decreasing. Association with preclinical factors suggests optimization of patient selection should be considered.

Patient- and Surgeon-Level Variation in Patient-Reported Sexual Function Outcomes Following Radical Prostatectomy Over 2 Years

“…1 However, patients such as these who are managed with active surveillance are likely to experience bet-ter sexual function outcomes compared to those managed with radical prostatectomy. 2,3 Surgical improvements are important, but in this case, focusing on encouraging active surveillance in patients with low-risk cancer could have equal or greater improvements in sexual function outcomes.…”

“…Radical prostatectomy (RP) is the most frequently selected treatment choice for localized prostate cancer, yet has the potential to negatively affect sexual function, a key patient-reported outcome and integral component of health-related quality of life . Population-based studies estimate that 78% to 87% of patients have erectile dysfunction following RP, an outcome associated with patient distress, dissatisfaction, and decision regret .…”

A Phase 1 Trial of Highly Conformal, Hypofractionated Postprostatectomy Radiation Therapy

“…Over this same time period, there has been a trend towards an increase in the utilization of upfront surgical management of this risk stratum [2]. The co-occurrence of these two trends have created a growing population of men who will eventually require post-operative radiotherapy (PORT) [3]. This population experiences several barriers to completing radiotherapy including the length of a treatment course [4] and financial toxicity of treatment [5], providing a rationale for the development of novel hypofractionated dose schedules with the objectives of mitigating these barriers and maintaining oncologic efficacy without an undue decrement in long-term quality of life (QoL).…”

Development and Validation of Dynamic Multivariate Prediction Models of Sexual Function Recovery in Patients with Prostate Cancer Undergoing Radical Prostatectomy: Results from the MUSIC Statewide Collaborative

“…Radical prostatectomy (RP) is the treatment most frequently selected for localized prostate cancer and is curative for early-stage prostate cancer [1] , [2] . Although effective from the perspective of cancer control, RP has nontrivial potential morbidity.…”