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  • Original Article
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Clinical Research

Variation in the use of postoperative radiotherapy among high-risk patients following radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 19, pages 216–221 (2016)Cite this article

Subjects

Abstract

Background:

We used data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) to investigate the use of adjuvant and salvage radiotherapy (ART, SRT) among patients with high-risk pathology following radical prostatectomy (RP).

Methods:

For patients with pT3a disease or higher and/or positive surgical margins, we examined post-RP radiotherapy administration across MUSIC practices. We excluded patients with <6 months follow-up, and those that failed to achieve a postoperative PSA nadir ⩽0.1. ART was defined as radiation administered within 1 year post RP, with all post-nadir PSA levels <0.1 ng ml−1. Radiation administered >1 year post RP and/or after a post-nadir PSA ⩾0.1 ng ml−1 was defined as SRT. We used claims data to externally validate radiation administration.

Results:

Among 2337 patients undergoing RP, 668 (28.6%) were at high risk of recurrence. Of these, 52 (7.8%) received ART and 56 (8.4%) underwent SRT. Patients receiving ART were younger (P=0.027), more likely to have a greater surgical Gleason sum (P=0.009), higher pathologic stage (P<0.001) and received treatment at the smallest and largest size practices (P=0.011). Utilization of both ART and SRT varied widely across MUSIC practices (P<0.001 and P=0.046, respectively), but practice-level rates of ART and SRT administration were positively correlated (P=0.003) with lower ART practices also utilizing SRT less frequently. Of the 88 patients not receiving ART and experiencing a PSA recurrence ⩾0.2 ng ml−1, 38 (43.2%) progressed to a PSA ⩾0.5 ng ml−1 and 20 (22.7%) to a PSA ⩾1.0 ng ml−1 without receiving prior SRT. There was excellent concordance between registry and claims data κ=0.98 (95% CI: 0.94–1.0).

Conclusions:

Utilization of ART and SRT is infrequent and variable across urology practices in Michigan. Although early SRT is an alternative to ART, it is not consistently utilized in the setting of post-RP biochemical recurrence. Quality improvement initiatives focused on current postoperative radiotherapy administration guidelines may yield significant gains for this high-risk population.

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Acknowledgements

Michigan Urological Surgery Improvement Collaborative (MUSIC) is funded by Blue Cross Blue Shield of Michigan (BCBSM). BCBSM provided funding for the collection and management of the data, but had no role in the design and conduct of the study, the analysis and interpretation of the data, the preparation, review or approval of the manuscript, or the decision to submit the manuscript for publication. We acknowledge the significant contribution of the clinical champions, urologists and data abstractors in each participating MUSIC practice (details around specific participating urologists and practices can be found at www.musicurology.com). In addition, we acknowledge the support provided by the Value Partnerships program at BCBSM. We also acknowledge the contributions of the Michigan Data Collaborative for their compilation of the claims data necessary for the validation processes. This work was supported by Blue Cross Blue Shield of Michigan. TMM is supported by the Department of Defense Physician Research Training Award (W81XWH-14-1-0287), Prostate Cancer Foundation Young Investigator Award and by the Alfred A. Taubman Institute.

Author information

Authors and Affiliations

  1. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    T M Morgan, S R Hawken, K R Ghani, D C Miller, S M Linsell, Y Gao & J E Montie

  2. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    F Y Feng

  3. West Shore Urology, Muskegon, MI, USA

    J A Salisz

  4. Department of Urology, Wayne State University, Detroit, MI, USA

    M L Cher

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  1. T M Morgan
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Correspondence to T M Morgan.

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Competing interests

TMM is a consultant/advisor for and receives research funding from Myriad Genetics. KRG is a consultant/advisor for Lumenis and Boston Scientific, and receives salary support from Blue Cross Blue Shield of Michigan as the co-director of the Michigan Urological Surgery Improvement Collaborative. DCM receives salary support from Blue Cross Blue Shield of Michigan as the director of the Michigan Urological Surgery Improvement Collaborative and the Michigan Value Collaborative. FYF has a leadership role at PFS Genomics, is a consultant/advisor for Medivation/Astellas, GenomeDx Biosciences and Celgene, and has research funding from Varian, Celgene and Medivation/Astellas. JEM is a consultant/advisor for and has ownership in Histosonics. MLC was part of Astellas-Medivation speaker’s bureau. The remaining authors declare no conflict of interest.

Additional information

This study was presented at the 2015 American Urological Association annual meeting.

Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Morgan, T., Hawken, S., Ghani, K. et al. Variation in the use of postoperative radiotherapy among high-risk patients following radical prostatectomy. Prostate Cancer Prostatic Dis 19, 216–221 (2016). https://doi.org/10.1038/pcan.2016.9

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