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. 2014 Dec;192(6):1650-6.
doi: 10.1016/j.juro.2014.06.017. Epub 2014 Jun 12.

Current clinical presentation and treatment of localized prostate cancer in the United States

Usama Mahmood  1 , Lawrence B Levy  2 , Paul L Nguyen  2 , Andrew K Lee  2 , Deborah A Kuban  2 , Karen E Hoffman  2
Affiliations

Current clinical presentation and treatment of localized prostate cancer in the United States

Usama Mahmood et al. J Urol. 2014 Dec.

Abstract

Purpose: SEER recently released patient Gleason scores at biopsy/transurethral resection of the prostate. For the first time this permits accurate assessment of prostate cancer presentation and treatment according to clinical factors at diagnosis.

Materials and methods: We used the SEER database to identify men diagnosed with localized prostate cancer in 2010 who were assigned NCCN(®) risk based on clinical factors. We identified sociodemographic factors associated with high risk disease and analyzed the impact of these factors along with NCCN risk on local treatment.

Results: Of the 42,403 men identified disease was high, intermediate and low risk in 38%, 40% and 22%, respectively. On multivariate analysis patients who were older, nonwhite, unmarried or living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease (each p <0.05). Of the 38,634 men in whom prostate cancer was the first malignancy 23% underwent no local treatment, 40% were treated with prostatectomy, 36% received radiation therapy and 1% underwent local tumor destruction, predominantly cryotherapy. On multivariate analysis patients who were older, black, unmarried or living in a county with a higher poverty rate, or who had low risk disease were less likely to receive local treatment (each p <0.05).

Conclusions: Our analysis provides information on the current clinical presentation and treatment of localized prostate cancer in the United States. Nonwhite and older men living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease and less likely to receive local treatment.

Keywords: healthcare disparities; neoplasm grading; prostate; prostatic neoplasms; risk.

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Figures

Figure 1
Figure 1
NCCN risk stratification (A) for all patients, (B) by race/ethnicity, and (C) by age (all p < 0.001).
Figure 1
Figure 1
NCCN risk stratification (A) for all patients, (B) by race/ethnicity, and (C) by age (all p < 0.001).
Figure 1
Figure 1
NCCN risk stratification (A) for all patients, (B) by race/ethnicity, and (C) by age (all p < 0.001).
Figure 2
Figure 2
Local treatment (A) for all patients, (B) by race/ethnicity, (C) by age, and (D) by NCCN risk (all p < 0.001).
Figure 2
Figure 2
Local treatment (A) for all patients, (B) by race/ethnicity, (C) by age, and (D) by NCCN risk (all p < 0.001).
Figure 2
Figure 2
Local treatment (A) for all patients, (B) by race/ethnicity, (C) by age, and (D) by NCCN risk (all p < 0.001).
Figure 2
Figure 2
Local treatment (A) for all patients, (B) by race/ethnicity, (C) by age, and (D) by NCCN risk (all p < 0.001).
See this image and copyright information in PMC

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