Abstract
Background
Contemporary treatment trends for prostate cancer show increased rates of active surveillance.
However, nationwide applicability of these reports is limited. Additionally, the effect
of Commission on Cancer facility type on prostate cancer treatment patterns is unknown.
Patients and Methods
We used the National Cancer Data Base to identify men diagnosed with prostate cancer,
between 2004 and 2013. Our cohort was stratified on the basis of the National Comprehensive
Cancer Network prostate cancer risk classes. Cochran–Armitage tests were used to evaluate
temporal trends. Random effects hierarchical logit models were used to assess treatment
variation at Commission on Cancer facility and institution level.
Results
In 825,707 men, utilization of radiation therapy declined and utilization of radical
prostatectomy increased for all prostate cancer risk groups between 2004 and 2013
(P < .0001). Observation for low-risk prostate cancer increased from 16.3% in 2004 to
2005 to 32.0% in 2012 to 2013 (P < .0001). Significant treatment variation was observed on the basis of Commission
on Cancer facility type. Across all risk groups, the lowest rates of radical prostatectomy
and highest rates of external beam radiation therapy were observed in community cancer
programs. The highest rates of observation for low-risk disease were observed in academic
centers. Treatment variation according to institution ranged from 14% (95% confidence
interval, 0.12-0.15) for androgen deprivation therapy up to 59% (95% confidence interval,
0.45-0.73) for cryotherapy.
Conclusion
The increased utilization of observation in low-risk prostate cancer is an encouraging
finding, which appears to be mainly derived by a decrease in radiotherapy utilization
in this risk group. Regardless of tumor characteristics, significant variations in
treatment modality exist among different facility types and institutions.
Keywords
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Article info
Publication history
Published online: April 25, 2017
Accepted:
April 14,
2017
Received in revised form:
April 5,
2017
Received:
February 25,
2017
Footnotes
B.L. and A.S. contributed equally to this work.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
