National trends in management of localized prostate cancer: A population based analysis 2004‐2013
- 14 March 2018
- journal article
- research article
- Published by Wiley in The Prostate
- Vol. 78 (7), 512-520
- https://doi.org/10.1002/pros.23496
Abstract
Recent years have brought many changes in the management of localized prostate cancer as national screening guidelines have been updated and diagnostic practice patterns evolved. We sought to better understand how the changing landscape influenced treatment utilization in the United States. We used the SEER database in this retrospective analysis of patients with clinically localized prostate cancer between 2004 and 2013. We evaluated utilization of primary treatment modalities over time with descriptive and trend analyses, and examined treatment utilization by cancer risk group and age at diagnosis. Of 398 074 patients in the analytic data set, 38% elected radiation therapy, 38% underwent radical prostatectomy, and 24% opted for expectant management. While in 2004 radiation treatment was almost twice as common as expectant management (42% vs 23%), by 2013 approximately equal percentages of patients were treated with each of the three modalities. Expectant management use increased over time, while the proportion of patients opting for surgery decreased remarkably with increasing age at diagnosis in intermediate- and higher-risk disease. Among radiotherapy options, brachytherapy was most common among lower-risk patients in 2004 but substantially decreased over time (P < 0.001). Management of localized prostate cancer changed substantially over time in the United States. Utilization of expectant management has increased for men with low- and intermediate risk cancer. Among those who pursue curative therapy, younger men remain more likely to elect surgery whereas older men tend to choose radiotherapy. Further studies are needed to better characterize factors contributing to treatment selection.Keywords
This publication has 29 references indexed in Scilit:
- A comparative dosimetric analysis of virtual stereotactic body radiotherapy to high-dose-rate monotherapy for intermediate-risk prostate cancerBrachytherapy, 2013
- MRI–ultrasound fusion for guidance of targeted prostate biopsyCurrent Opinion in Urology, 2013
- Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation StatementAnnals of Internal Medicine, 2012
- Bias Due to Missing SEER Data in D'Amico Risk Stratification of Prostate CancerJournal of Urology, 2012
- Comparative analysis of prostate‐specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study GroupBJU International, 2012
- Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate CancerJournal of Clinical Oncology, 2011
- Time Trends and Local Variation in Primary Treatment of Localized Prostate CancerJournal of Clinical Oncology, 2010
- Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation StatementAnnals of Internal Medicine, 2008
- Incidence of Initial Local Therapy Among Men With Lower-Risk Prostate Cancer in the United StatesJNCI Journal of the National Cancer Institute, 2006
- The Surveillance, Epidemiology, and End-Results Program Database as a Resource for Conducting Descriptive Epidemiologic and Clinical StudiesJournal of Clinical Oncology, 2003