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Clinical Research

Contemporary management of men with high-risk localized prostate cancer in the United States

Prostate Cancer and Prostatic Diseases volume 20, pages 283–288 (2017)Cite this article

Subjects

A Corrigendum to this article was published on 10 November 2017

Abstract

Background:

Surgery and radiation-based therapies are standard management options for men with clinically localized high-risk prostate cancer (PCa). Contemporary patterns of care are unknown. We hypothesize the use of surgery has steadily increased in more recent years.

Methods:

Using the National Cancer Data Base for 2004–2013, all men diagnosed with high-risk localized PCa were identified using National Comprehensive Cancer Network criteria. Temporal trends in initial management were assessed. Multivariable logistic regression was used to evaluate demographic and clinical factors associated with undergoing radical prostatectomy (RP).

Results:

In total, 127 391 men were identified. Use of RP increased from 26% in 2004 to 42% in 2013 (adjusted risk ratio (RR) 1.51, 95% CI 1.42–1.60, P<0.001), while external beam radiation therapy (EBRT) decreased from 49% to 42% (P<0.001). African American men had lower odds of undergoing RP (unadjusted rate of 28%, adjusted RR 0.69, 95% CI 0.66–0.72, <0.001) compared to White men (37%). Age was inversely associated with likelihood of receiving RP. Having private insurance was significantly associated with the increased use of RP (vs Medicare, adjusted odds ratio 1.04, 95% CI 1.01–1.08, P=0.015). Biopsy Gleason scores 8–10 with and without any primary Gleason 5 pattern were associated with decreased odds of RP (vs Gleason score ⩽6, both P<0.001). Academic and comprehensive cancer centers were more likely to perform RP compared to community hospitals (both P<0.001).

Conclusion:

The likelihood of receiving RP for high-risk PCa dramatically increased from 2004 to 2013. By 2013, the use of RP and EBRT were similar. African American men, elderly men and those without private insurance were less likely to receive RP.

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Authors and Affiliations

  1. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    A B Weiner, R S Matulewicz & E M Schaeffer

  2. Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA

    S L Liauw

  3. Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    J M Feinglass

  4. Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA

    S E Eggener

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  1. A B Weiner
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  2. R S Matulewicz
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  4. S L Liauw
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Correspondence to S E Eggener.

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Additional information

A poster version of these data was presented at the 16th Annual Meeting of the Society of Urologic Oncology in Washington, DC, December 2015.

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

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Weiner, A., Matulewicz, R., Schaeffer, E. et al. Contemporary management of men with high-risk localized prostate cancer in the United States. Prostate Cancer Prostatic Dis 20, 283–288 (2017). https://doi.org/10.1038/pcan.2017.5

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