Trends in the use of postprostatectomy therapies for patients with prostate cancer: A Surveillance, Epidemiology, and End Results Medicare analysis

Abstract

BACKGROUND: For patients with adverse pathologic factors (positive surgical margins, extracapsular extension, or seminal vesicle invasion) on prostatectomy pathology, the use and timing of postsurgical treatments are controversial. The goal of the current study was to examine patterns of care in patients with a pathologic indication for postprostatectomy radiotherapy (RT) using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. METHODS: A total of 3460 men treated with radical prostatectomy for localized prostate cancer between 2000 and 2006 with at least 1 adverse pathologic factor and at least 3 years of claims data after surgery were included. Medicare claims through December 31, 2009 were examined. Rates of postprostatectomy hormonal therapy, RT, or both were examined. Logistic regression analysis examined potential factors associated with the receipt and timing of RT. RESULTS: Within 3 years after surgery, 1076 patients (31%) received some form of further therapy, including 850 (25%) who received RT. Receipt of RT was < 35% in all subgroups including every year of study. Fewer than one-half of patients who received RT (43%) did so within 6 months of surgery. On multivariate analysis, pathologic T classification and tumor grade were associated with receipt of RT within 6 months or 3 years of surgery, as were younger age, geographic region, and population density. CONCLUSIONS: Rates of postprostatectomy RT remain low and the timing of RT has not appreciably changed since the publication of the randomized trials supporting the use of adjuvant RT. The use of hormone therapy is almost as common as RT, despite a relative lack of evidence supporting its use in this setting. Cancer 2013;119:3295-301.

Declining Use of Radiotherapy for Adverse Features After Radical Prostatectomy: Results From the National Cancer Data Base

“…Our findings of a higher rate of adjuvant RT use in younger patients, those with no significant comorbidities, pT3/T4 disease and a positive surgical margin, and Gleason score 8-10 histology is consistent with other reports [14,15,20]. For example, one study [14] reported threefold higher odds of receiving adjuvant RT for pT3a disease compared with pT2 disease and twofold higher odds of receiving RT for patients with Gleason score 8-10 compared with Gleason score 7.…”

“…Previous reports have demonstrated that the use of postoperative RT for PCa with adverse pathologic features did not increase after the publication of the aforementioned randomized trials [14,15]. These reports relied on the Surveillance, Epidemiology, and End Results (SEER) or linked SEER-Medicare databases for their analyses and were able to comment only on patterns of care for elderly patients (aged >65 yr) or lacked sufficient follow-up data to fully capture changes in practice patterns occurring in recent years and after publication of updated reports from these randomized trials.…”

National Trends in the Recommendation of Radiotherapy After Prostatectomy for Prostate Cancer Before and After the Reporting of a Survival Benefit in March 2009

“…Previous studies that included patients diagnosed through 2006 or 2007 did not find an increase in PPRT utilization or recommendations after the SWOG 87-94 and EORTC 22911 trials initially demonstrated improvements in bRFS, 13,14 suggesting that providers were not sufficiently moved by these results to change their practice. Similarly, we did not find an increase in PPRT recommendations after the initial publications that demonstrated improvements in bRFS.…”

“…7 Previous studies have attempted to characterize the trends in postprostatectomy RT (PPRT) use and recommendations after publication of the RCTs using the Surveillance, Epidemiology and End Results (SEER) and SEER-Medicare linked databases. 13,14 These studies did not show an increase after the RCTs demonstrated improved bRFS; however, the study cohorts were not able to include data from patients who were diagnosed and received surgery after 2009 when the survival benefit was published because SEER did not yet release information beyond 2007 at the times of the studies. Recent updates to the SEER program include data up to 2011, allowing for more rigorous and accurate exploration of PPRT recommendation trends after the publication of the survival benefit in 2009.…”

Assessing guideline impact on referral patterns of postprostatectomy patients to radiation oncologists

“…[17][18][19][20][21][22] Sineshaw et al 23 looked at the National Cancer Data Base in the U.S. and found a significant drop in the utilization rate of postoperative RT in prostate cancer patients with adverse pathological factors between 2005 and 2011 from 9.1-7.3%. However, this study and the other cited publications do not report the referral rates to a radiation oncology department.…”