Definitive treatment of localized prostate cancer: Time and geographic trends.

Abstract

132 Background: Numerous definitive treatment options exist for localized prostate cancer. We evaluated how the distribution of treatments varied by geographic location and over time in a contemporary US population database. Methods: All subjects with NCCN clinical risk-stratifiable localized prostate cancer between the years 2004 and 2011 were identified in the Surveillance Epidemiology and End-Results Database. Descriptive statistics evaluating the relative distribution of therapies by geographic region and over time were performed. Results: There were 290,631 evaluable subjects identified. The Table shows trends in treatment over time for combined low, intermediate, high, and very high risk prostate cancer. The use of brachytherapy has been significantly declining between 2004 and 2011, and no definitive therapy has been increasing. In 2010-2011, regional prostatectomy use varied from a low of 18% (Rural Georgia) to a high of 57% (Iowa). No definitive therapy rates varied between 12% (Hawaii) and 35% (Rural Georgia). Analyses of regional variation at the State County level reveals significant variability in the ratio of subjects receiving surgery to radiation (e.g., State of Utah surgery:radiation ratio 0.25 (Beaver County) versus 3.06 (Toole County). Conclusions: There is marked regional variation of practice at both the county and state levels for localized prostate cancer definitive therapy. The use of radiotherapy has been declining between the years 2004 and 2011, and appears to be offset by increases in no definitive therapy. Prostatectomy rates remained stable. [Table: see text]