MP11-05 TRENDS IN TREATMENT FOR MEN WITH CLINICALLY HIGH RISK PROSTATE CANCER FROM 1995-2007: RESULTS FROM SEER-MEDICARE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2014MP11-05 TRENDS IN TREATMENT FOR MEN WITH CLINICALLY HIGH RISK PROSTATE CANCER FROM 1995-2007: RESULTS FROM SEER-MEDICARE Andrew Harbin, Rachael Sussman, John Lynch, Jim Hu, and Keith Kowalczyk Andrew HarbinAndrew Harbin More articles by this author , Rachael SussmanRachael Sussman More articles by this author , John LynchJohn Lynch More articles by this author , Jim HuJim Hu More articles by this author , and Keith KowalczykKeith Kowalczyk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.420AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As primary treatment modalities for prostate cancer (PCa) improve and multiply, controversy has emerged over the approach to high risk disease. Although androgen deprivation and radiation have typically been the treatment of choice for clinical T3+ and high grade PCa, many authors have begun to advocate for surgery and multimodal therapy for appropriate men with high risk PCa. Utilizing population-based data, we analyzed the trends in treatment of high risk PCa from 1995-2007. METHODS Using SEER-Medicare linked data during 1995-2007, we identified 4,897 patients with clinical T3 or higher PCa who underwent radical prostatectomy (RP), radiation therapy (RT) or watchful waiting/active surveillance (WWAS). Trends in treatment as well as demographic and socioeconomic differences were compared. RESULTS 4,897 patients with high risk PCa underwent primary therapy with RP (n=473), RT (n=2258) or WWAS (n=2166). Older patients, and patients with more comorbidities were more likely to undergo WWAS (58.96% and 13.16%, respectively) and RT (38.66%; 9.26%) versus RP (7.82%; 4.23%). Married men were more likely to undergo RT (73.9%) or RP (78.0%), while unmarried men were more likely to undergo WWAS (28.58%) (Table 1). RP utilization increased over time for high risk PCa (Figure 1). CONCLUSIONS Over time, the utilization of RP for high risk PCa has increased, especially in younger, healthier men. This may represent an evolving treatment paradigm for high risk disease, though further study on outcomes are needed. Table 1. Demographic data of high risk prostate cancer patients undergoing treatment RP RT WWAS P Value Year of Diagnosis 1995 11 (2.33%) 123 (5.45%) 136 (6.28%) <0.0001 1996 19 (4.02%) 130 (5.76%) 101 (4.66%) 1997 10 (2.11%) 120 (5.31%) 103 (4.76%) 1998 15 (3.17%) 126 (5.58%) 117 (5.40%) 1999 14 (2.96%) 126 (5.58%) 113 (5.22%) 2000 53 (11.21%) 207 (9.17%) 245 (11.31%) 2001 26 (5.50%) 236 (10.45%) 190 (8.77%) 2002 21 (4.44%) 222 (9.83%) 195 (9.00%) 2003 37 (7.82%) 184 (8.15%) 179 (8.26%) 2004 57 (12.05%) 210 (9.30%) 228 (10.53%) 2005 65 (13.74%) 186 (8.24%) 205 (9.46%) 2006 73 (15.43%) 202 (8.95%) 197 (9.10%) 2007 72 (15.22%) 186 (8.24%) 157 (7.25%) Age at Diagnosis 65-69 299 (63.21%) 616 (27.28%) 411 (18.98%) <0.0001 70-74 137 (28.96%) 769 (34.06%) 478 (22.07%) 75+ 37 (7.82%) 873 (38.66%) 1277 (58.96%) Charleson Index 0 363 (76.74%) 1652 (73.16%) 1460 (67.41%) <0.0001 1 90 (19.03%) 397 (17.58%) 421 (19.44%) 2+ 20 (4.23%) 209 (9.26%) 285 (13.16%) Race White/Non-Hispanic 395 (83.51%) 1813 (80.29%) 1612 (74.42%) <0.0001 Black/Non-Hispanic 40 (8.46%) 179 (7.93%) 277 (12.79%) Hispanic 19 (4.02%) 156 (6.91%) 150 (6.93%) Asian/Non-Hispanic 19 (4.02%) 110 (4.87%) 127 (5.86%) Marital Status Not Married 74 (15.64%) 483 (21.39%) 619 (28.58%) <0.0001 Married 369 (78.01%) 1668 (73.87%) 1331 (61.45%) Unknown 30 (6.34%) 107 (4.74%) 216 (9.97%) Residency Metropolitan 420 (88.79%) 2040 (90.35%) 1899 (87.67%) 0.017 Non-Metropolitan 53 (11.21%) 218 (9.65%) 267 (12.33%) Grade Poorly 324 (68.50%) 1437 (63.64%) 1548 (71.47%) <0.0001 Well/Moderately 149 (31.50%) 821 (36.36%) 618 (28.53%) Clinical Stage T3 412 (87.10%) 1934 (85.65%) 1445 (66.71%) <0.0001 T4 61 (12.89%) 324 (14.35%) 721 (33.28%) PSA at Diagnosis Elevated 311 (65.75%) 1592 (70.50%) 1446 (66.76%) <0.0001 Normal 48 (10.15%) 144 (6.38%) 78 (3.60%) Unknown 114 (24.10%) 522 (23.12%) 642 (29.64%) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e96-e97 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Andrew Harbin More articles by this author Rachael Sussman More articles by this author John Lynch More articles by this author Jim Hu More articles by this author Keith Kowalczyk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...