Localized Prostate Research Articles

Is salvage focal cryotherapy curative treatment for patients with localized recurrent prostate cancer?

26 Background: The salvage therapy options for patients with recurrent unilateral prostate cancer after primary radiation, or cryotherapy, are limited. Salvage focal cryotherapy is becoming a more popular treatment option as it has shown success in its disease-free survival rates. Salvage focal cryotherapy enables patients to delay or negate the use of hormone therapy, which has many unfavorable adverse effects. The aim of this study is to report on the curative success of salvage focal cryotherapy in patients with recurrent unilateral prostate cancer. Methods: We identified patients who underwent salvage focal cryotherapy at Winthrop University Hospital between February 2011 and August 2015. Age at the time of treatment, follow-up time, nadir PSA levels, and follow-up treatments were assessed. Results: From 2011 to 2015, 88 patients underwent salvage focal cryoablation. Of these patients, 14 (15.9%) required another therapy treatment after salvage focal cryoablation. Hormone therapy was a necessary treatment for 9 patients. Only 6 patients (6.8%) went on to hormone therapy due to an MRI finding of a local, nodal, or distant relapses. Three (3.4%) patients went on to hormone therapy due to a rise in PSA. Conclusions: Focal salvage therapy is associated with very low risk of clinical and radiographic progression of cancer. In our patients with radiation recurrent cancer, we were able to prevent or delay the use of hormone therapy in the majority of these men. [Table: see text]

Cardiovascular events in prostate cancer patients: A comparative analysis of German claims data.

232 Background: In addition to the radical prostatectomy and radiotherapy, androgen deprivation therapies (ADT) have been established as a therapy option in patients with high-risk localized and metastatic prostate cancer (PCa). ADT was found to be associated with a higher risk for cardiovascular (CV) events. This retrospective claims-based study investigated whether CV event rates differ following initiation of ADT with gonadotropin-releasing hormone (GnRH) agonists or antagonists and PCa patients not treated with ADT. Methods: Analyses were based on claims data from the research database of the Health Risk Institute. Eligibility criteria included a PCa diagnosis between 2009 and 2013 and the initiation of ADT with GnRH agonists or antagonists or no ADT during follow up. Outcomes of interest included a composite endpoint of myocardial infarction (MI) or ischemic stroke (IS) as well as the occurrence of a CV event. The latter included MI, sequelae of cerebrovascular disease, IS, intracerebral hemorrhage, pulmonary embolism, phlebitis/thrombophlebitis, transient cerebral ischemic attacks and occlusion/stenosis of cerebral arteries. Results: ADT patients suffered from more comorbidities, were older, and were more likely to suffer from CV conditions than patients with no ADT during baseline. Patients treated with GnRH agonists and antagonists were comparable in terms of mean age and burden of comorbidities. The raw event rates for MI/IS and for CV events during follow up were higher in ADT patients than in patients without ADT (Table 1). Patients treated with GnRH agonists suffered more often from a CV event during follow-up than patients treated with antagonists. Conclusions: Our results indicate that ADT with GnRH antagonists is associated with fewer CV events in PCa patients than treatment with GnRH agonists. The results confirm findings from a pooled analysis of six phase III randomized controlled trials (Albertsen P. et al: Eur Urol 65 (2014) 565-573.). [Table: see text]

Causes of death in intermediate- and high-risk prostate cancer treated with radiotherapy with or without androgen deprivation therapy: Analysis from two phase III trials.

34 Background: The purpose of this analysis was to establish causes of death in a population of intermediate-risk (IR) and high-risk (HR) prostate cancer treated on two phase III trials. Methods: From October 2000 to September 2010, 1,230 patients were randomized: 630 with HR (ClinicalTrials.gov, #NCT00223171) and 600 with IR (#NCT00223145). HR was defined as T3-4, PSA >20 g/ml, Gleason >7 (with at least one of these 3 factors). IR was defined as T1-T2, Gleason < 6 and PSA 10-20 ng/ml or T1-T2, Gleason 7 and PSA < 20 ng/ml. Causes of death were compiled until July 2015 and were established from data sent by the different investigators and centrally reviewed. Causes of death were mainly based on data from clinical records, then by family members, obituaries, death certificates and family physicians. Results: The median follow-up for the 1,230 patients was 7.5 years (HR 8 vs. IR 6.8 years, p<0.001). 30.2% (372/1,230) patients had died: (HR 37% vs. IR 23.2%, p<0.001). A total of 8% (99/1,230) patients developed local, regional, and metastatic prostate cancer recurrences: (HR 11.6% vs. IR 4.3%, p<0.001) and 4.4% (54/1,230) died from prostate cancer: (HR 7.3% vs. IR 1.3%, p<0.001). The most frequent cause of death was a second cancer (120/1,230, 9.8%): (HR 10.6% vs. IR 8.8%, p=NS). Cardiovascular deaths occurred in 6.3% (78/1,230) (HR 7.1% vs. IR 5.5%, p=NS) with no statistical difference between the different durations of androgen deprivation therapy (ADT) 0, 6, 18, or 36 months. Other causes of death were pulmonary (3.7%), digestive (1.1%), others (3.3%), and unknown (1.7%). Majority of deaths occurred between 3 and 9 years after randomization (HR 70% and IR 73%). Prostate cancer deaths were distributed over all the follow-up period. The 5/10 year overall survival between HR and IR were 88.6%, 91.8%, and 61.6%, 69.8%, respectively with significant differences (p=0.045 and p=0.016). Conclusions: In patients with localized HR and IR prostate cancer, the first cause of death was a second cancer and prostate cancer came as the third one after cardiovascular disease. There was no statistical difference in the incidence of cardiovascular deaths in patients treated with different durations of ADT. Clinical trial information: Clinical Trials, gov. #NCT00223145 - Clinical Trials, gov. #NCT00223171.

Effect of androgen deprivation therapy on intraductal carcinoma of the prostate (IDC-P), a prognostic factor for prostate cancer.

146 Background: The presence of intraductal carcinoma of the prostate (IDC-P) is reported to be an adverse prognostic factor for cancer-specific survival (CSS) in localized and metastatic prostate cancer patients. However, there is no data indicating whether the presence of IDC-P can be affected by ADT (androgen deprivation therapy). Methods: We retrospectively evaluated 152 high risk prostate cancer patients who underwent radical prostatectomy with neoadjuvant ADT. They were diagnosed and treated at author-affiliated hospitals between 1991 and 2005. All patient data was made available from slides prepared from prostate needle biopsy samples and prostatectomy specimens and each patient received ADT before operation. Slides were re-reviewed by a single genitourinary pathologist (T.T.) according to the 2005 International Society of Urological Pathology (ISUP) grading system and presence of IDC-P was defined using previously published diagnostic criteria. Results: Patient median age was 68 years (range 46-80 years). The median iPSA was 32.7 ng/ml (range 2.4-296). The median follow-up period was 109 months (range 11-257). Sixty-one patients (40%) were ≥cT3 and 113 cases (74%) had biopsy Gleason score ≥8. Preoperative median ADT period was 4 months (range 1–20 ). IDC-P component was detected in 54 patients (36%) in needle biopsy and 69 (45%) in prostatectomy. There were 28 patients who died of the disease and 12 patients who died of other causes during follow-up. They were divided in 4 groups according to with or without IDC-P in biopsy/prostatectomy (-/- 68cases ,-/+ 30, +/- 15, +/+ 39). Twenty eight per cent of IDC-P positive cases in biopsy showed disappearance of IDC-P in prostatectomy specimen. Prognosis was the worst in +/+ group and IDC-P disappearance cases (+/-) tended to have better survival than IDC-P existing cases (+/+) in CSS (p = 0.04). Conclusions: In a number of IDC-P-positive cases determined by needle biopsy, the disappearance of IDC-P in prostatectomy specimens after ADT indicates the possibility that part of IDC-P positive patients can occasionally respond to ADT.

A phase I/IIa trial of prostate specific membrane antigen (PSMA) positron emission tomography (PET) imaging with 89Zr-Df-IAB2M in metastatic prostate cancer (PCa).

287 Background: There is a pressing need for improved imaging biomarkers to identify disease distribution and response in both localized and advanced prostate cancer patients. PSMA-directed imaging is undergoing analytic and clinical validation for these contexts of use. IAB2M is an anti-PSMA recombinant minibody (Mb) derived from huJ591. We have previously reported on 28 pts imaged with IAB2M(Pandit-Taskar et al, SNM 2015). Here we report the lesion targeting and uptake (SUV) of the Mb and correlation with pathology of biopsied lesions on the full complement of the 38 pts examined in this trial. Methods: 38 pts with progressive metastatic PCa received escalating amounts of the Mb (16 pts at 10mg, 16 pts at 20mg, 6 pts at 50mg) in a phase I/IIa trial. All pts underwent standard imaging (SI) using CT, bone scintigraphy (BS), FDG PET, followed by imaging with 5 mCi of IAB2M. Whole body PET/CT scans were performed and evaluated for lesion targeting and SUVmax. Biopsy (bx) locations were selected by a consensus panel prioritized on the basis of: IAB2M & FDG positivity, IAB2M & FDG mismatch, and CT or BS positivity & any PET mismatch. Results: A total of 556 lesions (410 bone, 146 soft tissue) in 38 pts were detected by SI or IAB2M. In bone, IAB2M detected 344 lesions (83.9%), CT 209 (51%), BS 211 (51.5%), and FDG 109 (26.6%). For soft tissue, IAB2M detected 119 (81.5%), CT 83 (56.8%), and FDG 79 (54.1%). The SUV for bone lesions ranged from 2.1-60.4 for 10mg Mb, 1.7- 33 in 20mg Mb, and 2.3-17.5 in 50mg Mb. For soft tissue lesions, SUV range was 3.1-45.4, 2.1-20, and 1.9-13.8 respectively. 28 bxs (13 bone, 15 soft tissue) were obtained from 27 pts; 27 bxs were evaluable (1 was non-diagnostic). 20/27 (74.1%) bxs were pos for PCa; 20/24 (83.3%) IAB2M pos lesions were path pos and 3/3 (100%) IAB2M neg lesions were neg on path. All imaging and path correlated (true pos + true neg) in 23/27 (85.2%) bxs. Conclusions: PET imaging with IAB2M has demonstrated higher lesion detection when compared with SI. IAB2M’s high concordance with path suggests pos findings represent bx confirmed PCa. Further studies to examine biochemically recurrent prostate cancer are planned. Clinical trial information: NCT01923727.

Psychological state and trait correlates of quality of life prior to radiotherapy for prostate cancer.

129 Background: Improvement in cancer treatment has increased need to focus on survivors’ quality of life (QOL). Survivors often experience psychological stress, with impact on QOL and disease-related mortality. Better understanding the heterogeneity in individuals’ psychological adjustment to cancer diagnosis and treatment may help identify the most valid screening practices and patients most in need of psychosocial support. The specific aim of the current study investigates correlates of psychological state and trait with QOL prior to radiotherapy for localized non-metastatic prostate cancer. We hypothesized 1) positive correlations with QOL and trait Extraversion, Openness, and Conscientiousness, and 2) negative correlations between QOL and state depression/anxiety and trait Neuroticism. Methods: The PHQ-9, GAD-7, and NEO-FFI-3 assessed depressive state, anxiety state, and personality traits, respectively. The FACT-P assessed physical, social, emotional, and functional well-being. Our sample (n=29) had median age of 68 (range 52-79) and education of 16 years (range 10-20). Race/ethnicity: 89% European-American, 4% African-American, 7% Other. Association between constructs was assessed by Pearson’s correlation coefficient. Results: Higher depression, anxiety, and Neuroticism were negatively associated with physical (p < 0.04), emotional (p < 0.01), and functional (p < 0.02) well-being, and well-being related to prostate cancer-specific concerns (p < 0.01). Trait Agreeableness was associated with emotional (p < 0.01) and functional (p < 0.01) well-being. Extraversion was associated with social (p < 0.05) and functional (p < 0.02) well-being. Openness was associated with functional well-being only (p < 0.03). Contrary to hypothesis, Conscientiousness did not significantly correlate with any measured aspect of QOL. Conclusions: Assessing psychological risk and protective factors prior to radiotherapy may help identify patients in most need of psychosocial supports, informing effective screening protocols and individualized treatment planning. Future directions include prospectively measuring predictive value of baseline risk and protective factors on post-treatment QOL.

Copy number alterations of P53, RB1, and MDM2 as prognostic markers in intermediate-risk prostate cancer.

117 Background: We interrogated copy number alternations (CNA) of p53, Rb1 and MDM2 as prognostic determinants of biochemical failure in localized intermediate-risk prostate cancer. Methods: Using Affymetrix Oncoscan array technology, we characterized copy number alterations (CNA) for 284 D’Amico-classified intermediate-risk prostate cancers. Of the 284 patients, 143 underwent image-guided radiotherapy (IGRT), while 141 underwent radical prostatectomy (RadP). Biochemical-relapse free survival (bRFS) was assessed as a clinical end-point, with biochemical failure defined using the Phoenix and AUA criteria for IGRT and RadP patients, respectively. Results: We observed allelic losses ofp53 and Rb1 in 23.9% (n = 68) and 31.0% (n = 88) and allelic gains of MDM2 in 3.17% (n = 9) in our cohort, respectively. 7.7% (n = 22), 1.1% (n = 3) and 0.4% (n = 1) of all cases exhibited concurrent losses of p53 and Rb1, p53 loss and MDM2 gain, and concurrent p53/Rb1 loss and MDM2 gain, respectively. Patients with allelic losses of p53, Rb1 and allelic gain of MDM2 loci exhibited increased percent genome aberration (PGA) (Mean 9.2 vs. 6.1 p < 0.001; 10.1 vs. 5.4 p < 0.001; 18.1 vs. 6.5 p < 0.001 respectively). Rb1 loss and MDM2 gain were not significant predictors of bRFS, independent of treatment modality. Allelic loss of p53 was predictive of poor bRFS in the RadP cohort (HR = 1.86, 95% CI 1.10-3.16, p = 0.022), but not for IGRT patients (HR = 1.16, 95% CI 0.63-2.12, p = 0.629). Additionally, patients in the RadP cohort with concurrent losses of p53 and Rb1 also had a higher likelihood of poorer bRFS (HR = 2.32, 95% CI 1.1-4.93, p = 0.029). On multivariate analysis, incorporating PGA and pre-treatment PSA, concurrent p53/Rb1 losses, but not single p53 loss, was prognostic for bRFS in patients who underwent RadP (p53/Rb1 losses, HR = 2.16, 95% CI 1.0-4.65, Wald's p = 0.05; p53loss, HR = 1.62, 95% CI 0.94-2.79, Wald's p = 0.08). Conclusions: In a cohort of men with intermediate-risk prostate cancers, we identified an unfavourable subgroup of patients harbouring concurrent copy number losses of p53 and Rb1 that was associated with an adverse prognosis of biochemical failure following radical prostatectomy.

Post Irradiation Pelvic Sarcoma 8 Years after Treatment for Adenocarcinoma for Prostate: About a Case

Radiotherapy for prostate cancer can be associated with the development of second cancer, primely carcinoma and exceptionally sarcomas. We report a case of post irradiation pelvic sarcoma height years after external beam radiotherapy for localized T1c prostate adenocarcinoma. Eight years after the radiotherapy he showed a radio-induced high grade sarcoma. Although the use of external beam radiation therapy for the treatment of prostate cancer has been common practice for decades and despite such cases being regarded as extremely rare, post-irradiation sarcoma should be considered as a potential cause of pelvic pain developing after radiotherapy.

Evaluation of Posttreatment Follow-Up of Patients With Prostate Cancer Relative to the American College of Radiology's Appropriateness Criteria.

The American College of Radiology (ACR) Appropriateness Criteria panel has recommended that patients with prostate cancer who have received treatment undergo imaging only after suspected cancer recurrence. We examined whether local physicians followed this recommendation and what types of imaging examinations were ordered in a cohort of patients with local prostate cancer. The Rochester Epidemiology Project, a research consortium that collects, links, and stores medical record information of Olmsted County, Minnesota, residents, was used to capture the complete medical history of treated patients with prostate cancer from 2000 through 2011. Clinical information and imaging examinations performed were retrieved by chart review. Suspected recurrence was defined as treatment-specific prostate-specific antigen level elevations, bone pain, or abnormal digital rectal examination findings. Of the 670 treated patients with prostate cancer who were included in the final analysis, 129 (19%) underwent posttreatment imaging. After excluding imaging related to retreatment or another cancer, 13 patients (i.e., 2% of the entire cohort and 10% of imaged patients) underwent imaging in the absence of suspected recurrence. A total of 90 patients (70% of imaged patients) underwent imaging after suspected recurrence. Of these 90 patients, 62 (69%) underwent a bone scan as their first imaging modality either alone or in combination with other imaging modalities. Of the providers who ordered a bone scan first, 27% were urologists, 23% were radiation oncologists, and 24% were primary care physicians. Most patients in this study did not undergo imaging in the absence of suspected recurrence. Various types of imaging examinations were ordered for patients with suspected recurrence.

High-grade prostate adenocarcinoma (Gleason Score ≥8): survival and disease control following radical prostatectomy versus radiotherapy plus long-course hormone therapy

Objective The optimal primary intervention for treatment of clinically localized high-grade prostate cancer remains to be identified. The present investigation compares disease control in patients treated with primary radical prostatectomy (RP) versus radiotherapy (RT).

Effects of preoperative abiraterone acetate (AA) plus enzalutamide (E) and leuprolide acetate (LHRHa) versus AA and LHRHa in localized high-risk prostate cancer (LHRPC).

5061 Background: High degree of heterogeneity in cytoreduction has been observed in LHRPC following AA+LHRHa and LHRHa (Taplin et al, J Clin Oncol 2014;32:3705; Efstathiou et al, J Clin Oncol2012:3...

Post-treatment imaging—a desperate need for solid evidence

Many imaging techniques are currently used for detection of local or distant prostate cancer recurrences after primary treatment. A new retrospective registry study raises concerns about the pertinence of imaging test use after primary prostate cancer treatment. These findings emphasize the need for consensual guidelines on imaging in this setting.

PO-0712: Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

PO-0712: Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy

EP-1234: Hypofractionated radiotherapy in local recurrent prostate cancer after EBRT

EP-1234: Hypofractionated radiotherapy in local recurrent prostate cancer after EBRT

Focal therapy for prostate cancer: The current status.

PurposeIn an era of increasing prostate cancer incidence and earlier detection, the assessment of clinical significance of prostate cancer is critical. Minimally invasive therapies are increasingly being investigated in localized prostate cancer.Methods and resultsIn this review, we discuss the current status of magnetic resonance imaging targeted fusion prostate biopsy and focal therapy for prostate cancer, its rationale, and techniques.ConclusionFocal therapy offers a promising outlook for prostate cancer treatment, with the goal of effectively achieving cancer control while minimizing morbidity. Long term studies are needed.

1021 Effect of 6 months of androgen deprivation therapy on progression-free survival and quality of life in localized T1b-cT2aN0M0 prostate cancer

1021 Effect of 6 months of androgen deprivation therapy on progression-free survival and quality of life in localized T1b-cT2aN0M0 prostate cancer

Weekly paclitaxel versus ADT alone in localized high-risk prostate cancer: Results of a single-institution phase II trial.

37 Background: Adjuvant chemotherapy’s role after radical prostatectomy (RP) remains controversial in localized high-risk prostate cancer (HRPC). This phase II trial assessed the combination of weekly paclitaxel (WP) with androgen deprivation therapy (ADT) in this population. Methods: All eligible patients (pts) had undergone a laparoscopic RP with pelvic lymph node dissection for a localized HRPC defined with ≥1 of the following criteria: T3b-T4 post-operated Gleason score (GS) ≥8, PSA≥ 20 ng/mL, pN+, in Henri Mondor Hospital. Pts were randomly assigned to either triptoreline 11.25mg every 3 months during 3 years and 8 cycles of WP 100 mg/ m2 (WP arm, n=21) or triptoreline alone (ADT arm, n=26). The primary endpoint is disease free survival (DFS); events=PSA relapse, clinical and radiographic relapse, death. The planned number of pts was 152. Toxicity results indicated a good tolerability with neutropenic fever in 4.3% (n=1), and no negative impact on QoL in the WP arm (Ploussard, Prostate Cancer Prostatic Dis. 2010). Here we report 8-year DFS and overall survival (OS) results. Results: Between February 2005 and October 2007, 47 pts were enrolled. This trial was terminated prematurely because of slow accrual. After a mean follow-up of 8.4 y, we identified a PSA relapse in 25 pts (53%) and castrate-resistant prostate cancer occurred in 6 pts. No statistically difference was found in terms of either biochemical or clinical DFS (bDFS, cDFS) and OS: 8-year bDFS rate: 50% [n=11/22] in the WP arm vs 46% [n=12/26] in the ADT arm (p=0.79); 8-year cDFS rate: 95.4% [n=21/22] in the WP arm vs 88.5% [n=23/26] in the ADT arm (p=0.38). The 8-year OS rate is 90.9% (n=20/22) and 84.6% (n=22/26) respectively with no difference between treatment arms (p=0.51). No clinical, histological or biological variable demonstrated a difference in either 8-year bDFS, cDFS or OS rate. Conclusions: Provided that this trial is probably underpowered to detect a DFS benefit, adjuvant weekly paclitaxel after RP was not associated with any significant reduction in the risk of biological relapse or death compared to ADT alone in patients with localized HRPC. Chemotherapy should be only proposed in dedicated clinical trial for localized HRPC.

Propensity score matched analysis of metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy or radical prostatectomy.

47 Background: National Comprehensive Cancer Network (NCCN) category 1 recommendation for localized high risk prostate cancer (HR-PCa) is definitive radiation therapy (RT) and androgen deprivation therapy (ADT). Radical prostatectomy (RP) is also an accepted treatment for patients with localized HR-PCa. Here we report a propensity score-matched analysis of institutional outcomes for patients with HR-PCa treated with RP or RT. Methods: Medical recor ds of patients with localized NCCN HR-PCa treated at our institution from 2002-2011 were reviewed. RT consisted of 73.8-77.4 Gray to the prostate and seminal vesicles; regional lymph nodes were treated for pre-treatment probability of involvement ≥15%. A combination of nearest neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 score [a validated comorbidity index], prostate specific antigen (PSA), biopsy Gleason, and clinical T-stage (cT) and exact matching on PSA, biopsy Gleason, and cT was performed. Multivariate cox-proportional hazards regression was used to compare metastasis-free survival (MFS) and overall survival (OS) (calculated from date of diagnosis). Results: 246 patients were identified (160 RP and 86 RT). Propensity score matching resulted in 62 matched pairs. For the RP group, minimally invasive surgery (70.9%) and lymph node dissection (100%) were common. ADT was administered to 37.1% and 80.6% of patients receiving RP and RT, respectively. Median follow-up was longer for the RT group (51.4 vs 41 months, p = 0.004). Five-year rates of metastasis for RT and RP were 8.9% and 33% (p = 0.003), and for death were 25.9% and 17.6%, respectively (p = 0.31). MFS was significantly better for patients treated with definitive RT compared to RP, while OS was not different (Table). Conclusions: In our cohort with HR-PCa, treatment with RT resulted in a MFS advantage over RP. This was not accompanied by an improvement in OS.The difference in MFS may possibly be related to the importance of early adjuvant ADT. [Table: see text]

Contemporary trends in receipt of local therapy for men with clinically localized high-risk prostate cancer.

111 Background: Level I evidence suggests local treatment results in improved survival as compared to androgen deprivation therapy (ADT) alone or watchful waiting for high risk prostate cancer (CaP), but contemporary trends in primary treatment for high risk CaP are poorly understood. Our aim is to examine local therapy utilization for patients with high risk CaP using a large national cancer registry. Methods: Using the National Cancer Database (NCDB), patients with clinically localized CaP meeting National Comprehensive Cancer Network high risk criteria were identified from 2004-2009. Men with node positive or metastatic disease were excluded. Adjusting for diagnosis year and demographic we examined the association between patient characteristics and local therapy, defined as radical prostatectomy (RP) or radiation (RT), in men with high risk CaP using logistic regression models. Results: A total of 132,369 men met inclusion criteria with 80% receiving local therapy and 12% receiving no treatment. There was a small but significant increase in local therapy utilization from 2004-2009 (79 to 81%, p<0.001) with the largest changes seen in increased use of RP alone (24 to 31%, p<0.001) and decreased use of RT+ADT (33 to 29%, p<0.001). In comparison, minor changes were noted in the rates of RT alone (14 to 13%, p=0.02), RP+RT (2.2 to 2.9%, p<0.001), RP+RT+ADT (1.6 to 1.9%, p=0.01), and ADT alone (8.9 to 7.0%, p<0.001). Following adjustment, patients with age >70 years (OR 0.27, CI 0.23-0.30) or Charlson morbidity count > 2 (OR 0.43, CI 0.39-0.46) were less likely to receive local therapy. Further, men of African American race (OR 0.7, CI 0.67-0.74) and Medicare (OR 0.82, CI 0.77-0.87) or Medicaid (OR 0.6, 0.53-0.68) insurance were less likely to receive primary treatment than Caucasian patients or those with private insurance. Conclusions: In the NCDB, 80% of men presenting with clinically localized high risk CaP undergo local therapy as part of multimodality treatment or as monotherapy, with RP overtaking RT+ADT as the primary local treatment of choice. Furthermore, racial and insurance disparities in the receipt of primary treatment are still evident, providing targets for emerging CaP quality of care initiatives.