MP22-03 UTILIZATION OF SALVAGE RADIATION THERAPY FOR BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2018MP22-03 UTILIZATION OF SALVAGE RADIATION THERAPY FOR BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY Scott Hawken, Daniel E Spratt, Ji Qi, Susan M Linsell, Michael L Cher, Kurshid R Ghani, David C Miller, James E Montie, Todd M Morgan, and for the Michigan Urological Surgery Improvement Collaborative Scott HawkenScott Hawken More articles by this author , Daniel E SprattDaniel E Spratt More articles by this author , Ji QiJi Qi More articles by this author , Susan M LinsellSusan M Linsell More articles by this author , Michael L CherMichael L Cher More articles by this author , Kurshid R GhaniKurshid R Ghani More articles by this author , David C MillerDavid C Miller More articles by this author , James E MontieJames E Montie More articles by this author , Todd M MorganTodd M Morgan More articles by this author , and for the Michigan Urological Surgery Improvement Collaborativefor the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.714AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For men with biochemical recurrence after radical prostatectomy (RP), salvage radiation therapy (SRT), especially ″early″ SRT (PSA ≤0.5 ng/mL), is a potentially curative option. However, its utilization in clinical practice is not well defined. We sought to determine factors associated with SRT utilization as well as the variation in administration across diverse urology practices. METHODS Patients with localized prostate cancer (PCa) undergoing RP at 27 practices participating in the Statewide Michigan Urological Surgery Improvement Collaborative (MUSIC) between 2012-2016 were prospectively followed. Eligible patients for this study had at least 1 post-RP PSA ≥0.1 ng/ml. SRT utilization along with clinical and pathologic patient characteristics were examined, including PSA, pathologic stage, grade, margin status, race, Charlson comorbidity index, age, and insurance type. Associations with SRT use were analyzed using logistical regression modeling. RESULTS Of 1017 eligible patients with a detectable PSA, only 29.7% underwent SRT; 16.7%, 5.2%, 3.3%, and 4.5% of patients underwent SRT at PSA levels of 0.1 to <0.5, 0.5 to <1.0, 1.0 to <2.0, and ≥2.0 ng/mL, respectively. After adjusting for patient and practice level factors, higher maximum post-RP PSA, positive surgical margins, higher T-stage, and higher grade group were all associated with receipt of SRT (all p<0.05). Even after adjusting for patient and tumor characteristics, there remained significant variation in the adjusted rate of SRT utilization across practices sites, ranging from 3.5% (95% CI 0.5-15%) to 74% (95% CI 35-94%, p<0.001). Practices were grouped into tertiles based on SRT utilization, and those practices that utilized SRT more frequently overall were more likely to administer SRT across all patient-based predictors of SRT utilization (Figure). CONCLUSIONS Of men with a detectable PSA post-RP, one in six received early SRT, with significant variation in practice-level SRT utilization which can′t be explained by patient factors alone. Factors suggesting higher risk disease were predictors of SRT administration. These data support the potential to expand the use of SRT, particularly among low utilization sites. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e272 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Scott Hawken More articles by this author Daniel E Spratt More articles by this author Ji Qi More articles by this author Susan M Linsell More articles by this author Michael L Cher More articles by this author Kurshid R Ghani More articles by this author David C Miller More articles by this author James E Montie More articles by this author Todd M Morgan More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...