You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost effectiveness (III)1 Apr 2013414 VARIATION IN OVERTREATMENT OF PROSTATE CANCER IN FLORIDA Blake Evans, Carl Henriksen, Bruce Vogel, and Scott Gilbert Blake EvansBlake Evans Gainesville, Macedonia More articles by this author , Carl HenriksenCarl Henriksen Gainesville, FL More articles by this author , Bruce VogelBruce Vogel Gainesville, FL More articles by this author , and Scott GilbertScott Gilbert Gainesville, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1804AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many older men with prostate cancer continue to seek and receive treatment for localized disease, even though the treatment benefit is unclear and despite widely accepted recommendations to limit primary intervention to men with a 10-year or greater life expectancy. Although awareness of overtreatment has increased in recent years, little information is available about how common or variable it is. Accordingly, we sought to understand geographic differences in how prostate cancer is treated and to identify risk factors for overtreatment in a large, demographically diverse state with a large number of retirees. METHODS We used the Florida Cancer Data System (FCDS) to identify treated and untreated cases of prostate cancer between 2004 and 2007. The FCDS is a large statewide cancer registry that collects clinical, demographic and treatment information for incident cancers. We defined overtreatment as Gleason ≤ 7, stage ≤ T2 disease among men age ≥ 76 years. We used Geographic Information Systems (GIS) to map differences in the percent of overtreatment across Health Service Areas (HSAs) in Florida among older men (≥76 years) diagnosed with prostate cancer. We then examined risk factors for overtreatment using logistic regression. All analyses were performed using standard statistical software (SAS and ArcGIS). RESULTS Among men ≥ 76 years (n=8,081), 9.9% received surgery, 40.4% received external radiation therapy, 17.9% received brachytherapy, 7.1% received primary androgen deprivation therapy and 24.6% did not receive treatment. Overtreatment varied significantly across Florida, with overtreatment estimated in >86% of cases in 20% of HSAs (Figure). In logistic models, low percent census tract poverty (OR 1.42, 95% CI 1.10-1.84 for low vs. high poverty level) and shorter driving times to treatment centers (OR 0.89, 95% CI 0.85-0.93 for every 10 additional minutes) were associated with higher odds of overtreatment. CONCLUSIONS Treatment among older men with low- and intermediate-risk localized prostate cancer is more common than expectant management. The propensity for overtreatment varies considerably according to health care markets (HSAs) and demographic factors. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e168 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blake Evans Gainesville, Macedonia More articles by this author Carl Henriksen Gainesville, FL More articles by this author Bruce Vogel Gainesville, FL More articles by this author Scott Gilbert Gainesville, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...