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Comparative Study
. 2020 Dec;9(23):8754-8764.
doi: 10.1002/cam4.3482. Epub 2020 Oct 31.

Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer

Bryan Kaps  1 , Michael Leapman  1   2 , Yi An  2   3
Affiliations
Comparative Study

Trends in prostatectomy utilization: Increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer

Bryan Kaps et al. Cancer Med. 2020 Dec.

Abstract

We aimed to determine patterns in frequency of radiotherapy for prostate cancer and definitive surgical management. There is prospective evidence indicating benefits of radiotherapy for some patients after radical prostatectomy (prostatectomy), with recent evidence suggesting benefit of early salvage radiotherapy. Trends in postoperative radiotherapy have not been elucidated. We analyzed the National Cancer Database for prostate cancer patients treated with curative-intent therapy between 2004 and 2016. Patients were risk stratified according to NCCN treatment guidelines. Linear regression was utilized to examine trends in treatment with initial prostatectomy and trends in postoperative radiotherapy among treatment risk groups. Multivariable logistic regression was utilized to examine clinical-demographic variables associated with prostatectomy and postoperative radiotherapy. From 2004 to 2016, 508,450 patients received prostatectomy and 370,314 received radiotherapy. Median age was 63.6 years. There was increased utilization of prostatectomy from 47.9% in 2004 to 61.3% in 2016 (ptrend <0.001). 24,466 cases received postoperative radiotherapy. Similarly, postoperative radiotherapy utilization increased from 2.2% in 2004 to 4.0% in 2016 (ptrend <0.001). The subgroup with the largest increase in postoperative radiotherapy was clinically high-risk disease (5.3% in 2004 to 7.8% in 2016 (ptrend <0.001). Clinical high-risk disease (OR 1.751), Gleason 9-10 (OR 2.973), and PSA >20 ng/ml (OR 1.489) were factors predictive for postoperative radiotherapy. The proportion of prostate cancer patients who undergo definitive prostatectomy and postoperative radiotherapy is increasing. This increase is greatest in high-risk cases. Overall, the proportion of patients who receive any radiotherapy is decreasing. Association with preclinical factors suggests optimization of patient selection should be considered.

Keywords: Adjuvant Radiation Therapy; Prostate Cancer; Prostatectomy; Radiation; Treatment trends.

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Conflict of interest statement

The authors have no financial or non‐financial competing interests to declare.

Figures

Figure 1
Figure 1
Study inclusion and exclusion criteria are illustrated. +LN, Positive regional lymph nodes; Dx, Disease; NCDB, National Cancer Database; PSA, Prostate‐Specific Antigen; RP, Radical Prostatectomy; RT, Radiation Therapy; Tx, Treatment
Figure 2
Figure 2
Treatment patterns for curative therapy, with postoperative radiation therapy superimposed on pertinent radical prostatectomy cases. (A) Entire cohort and (B) High‐risk disease. RP, radical prostatectomy; RT, radiation therapy
Figure 3
Figure 3
Postoperative treatment patterns between 2004 and 2016. Low, Intermediate, and High legend labels correspond to NCCN disease severities low risk, intermediate risk, and high risk. RT, Radiation Therapy
See this image and copyright information in PMC

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