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. 2016 Mar;4(1):20-4.
doi: 10.1016/j.prnil.2015.11.001. Epub 2015 Dec 8.

Australian patterns of prostate cancer care: Are they evolving?

Jonathon Lo  1 , Nathan Papa  1 , Damien M Bolton  1 , Declan Murphy  2 , Nathan Lawrentschuk  3
Affiliations

Australian patterns of prostate cancer care: Are they evolving?

Jonathon Lo et al. Prostate Int. 2016 Mar.

Abstract

Background: Approaches to prostate cancer (PCa) care have changed in recent years out of concern for overdiagnosis and overtreatment. Despite these changes, many patients continue to undergo some form of curative treatment and with a growing perception among multidisciplinary clinicians that more aggressive treatments are being favored. This study examines patterns of PCa care in Australia, focusing on current rates of screening and aggressive interventions that consist of high-dose-rate (HDR) brachytherapy and pelvic lymph node dissection (PLND).

Methods: Health services data were used to assess Australian men undergoing PCa screening and treatment from 2001 to 2014. Age-specific rates of prostate-specific antigen (PSA) screening were calculated. Ratios of radical prostatectomy (RP) with PLND to RP without PLND, and HDR brachytherapy to low-dose-rate (LDR) brachytherapy were determined by state jurisdictions.

Results: From 2008, the rate of PSA screening trended downward significantly with year for all age ranges (P < 0.02) except men aged ≥ 85 (P = 0.56). PLND rates for 2008-2014 were lower than rates for 2001-2007 across all states and territories. From 2008 to 2014, PLND was performed ≥ 2.7 times more frequently in New South Wales and the Australian Capital Territory than in other jurisdictions. Since 2007, brachytherapy practice across Australia has evolved towards a relatively low use of HDR brachytherapy (ratio of HDR to LDR brachytherapy < 0.5 for all jurisdictions except the Australian Capital Territory).

Conclusion: Rates of PLND and HDR brachytherapy for PCa have declined in Australia, providing evidence for the effect of stage migration due to widespread PSA screening. Currently, PSA screening rates remain high among older men, which may expose them to unnecessary investigations and treatment-related morbidity.

Keywords: Brachytherapy; Lymph node excision; Mass screening; Prostatectomy; Prostatic neoplasms.

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Figures

Fig. 1
Fig. 1
The graph shows the ratio of radical prostatectomy (RP) with pelvic lymph node dissection (PLND) to RP without PLND across state jurisdictions between 2001–2007 and 2008–2014 (all years inclusive). The ratio of the Australian Capital Territory for 2001–2007 (black) exceeds the maximum y-axis.
Fig. 2
Fig. 2
The graph shows the ratio of high-dose-rate (HDR) brachytherapy to low-dose-rate (LDR) brachytherapy from 2007 to 2014. The ratio of the Australian Capital Territory for 2013–2014 exceeds the maximum y-axis.
Fig. 3
Fig. 3
The graph shows age-specific rates of PSA screening tests per 100,000 men for combined states and territories since 2001. PSA, prostate-specific antigen.
See this image and copyright information in PMC

References

    1. Wilt T.J., Brawer M.K., Jones K.M., Barry M.J., Aronson W.J., Fox S. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367:203–213. - PMC - PubMed
    1. Smith D.P., King M.T., Egger S., Berry M.P., Stricker P.D., Cozzi P. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ. 2009;339:b4817. - PMC - PubMed
    1. Bolenz C., Freedland S.J., Hollenbeck B.K., Lotan Y., Lowrance W.T., Nelson J.B. Costs of radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2014;65:316–324. - PubMed
    1. Weerakoon M., Papa N., Lawrentschuk N., Evans S., Millar J., Frydenberg M. The current use of active surveillance in an Australian cohort of men: a pattern of care analysis from the Victorian Prostate Cancer Registry. BJU Int. 2015;115(Suppl 5):50–56. - PubMed
    1. Evans S.M., Millar J.L., Davis I.D., Murphy D.G., Bolton D.M., Giles G.G. Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011. Med J Aust. 2013;198:540–545. - PubMed