Trends in the treatment of localized prostate cancer using supplemented cancer registry data

Abstract

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.

Historical Prostate Cancer Screening and Treatment Outcomes from a Single Institution

“…This is similar to the trends reported by NCI SEER outcomes (45% radical prostatectomy, 24% total radiation, 8% hormonal, and 9% watchful waiting) 31 and within the regional trends reported by the Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR) Patterns of Care (PoC1) study. 32 Once prostate cancer was detected, we also observed a decrease in the age of surgery with successive decades, with the average age of surgical intervention as early as 63 years for the current decade and more conservative treatment likely for older age at cancer diagnosis.…”

Optimization of Prostate Biopsy Referral Decisions

“…In the results we present, we assume patients detected with non-metastatic prostate cancer are treated by radical prostatectomy. Radical prostatectomy is historically the most common treatment (Burkhardt et al 2002, Kawachi et al 2010, Hamilton et al 2011) and reported to be the best treatment in terms of expected QALYs for all the ages (Sommers et al 2007). It is also the only form of treatment for which the patients' cancer stages can be understood by pathological examination of the removed organ.…”

Trends in prostate cancer in elderly in Denmark, 1980–2012

“…Prostate cancer is generally a disease of the elderly (70 years) and few men are diagnosed before the age of 50 years, the median age at being 68 years [3,4]. However, despite high incidence and mortality rates in the elderly, more studies suggest that the elderly are undertreated [5][6][7][8]. Recent guidelines state that age alone should not prelude patients from efficient treatment [9].…”