Factors associated with initial treatment and survival for clinically localized prostate cancer: results from the CDC-NPCR Patterns of Care Study (PoC1)

Abstract

BackgroundDespite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival.MethodsThe analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively.ResultsPatients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7%), radiation therapy (31.4%), hormone therapy (10.3%), or watchful waiting (18.6%). After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting): older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4), comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy), older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black race in patients under 60 years of age, were associated with receipt of radiation therapy. Overall survival was related to younger age, being married, Gleason score under 8, radical prostatectomy, and state of residence. Comorbidity was only associated with risk of death within the first three years of diagnosis.ConclusionsIn the absence of clear-cut evidence favoring one treatment modality over another, it is important to understand the factors that inform treatment selection. Since state of residence was a significant predictor of both treatment as well as overall survival, true regional differences probably exist in how physicians and patients select treatment options. Factors affecting treatment choice and treatment effectiveness need to be further explored in future population-based studies.

Comorbidities, Treatment and Ensuing Survival in Men with Prostate Cancer

“…[11][12][13][14][15] However, our findings are plausible since a single comorbid condition at the time of treatment may not seem overly concerning for a dismal prognosis. In fact, upon a more thorough review of the extant literature, one discovers that others also failed to find a significant difference in the treatment rate when comparing men with a Charlson Score of 1 or 2 vs. 0.…”

Historical Prostate Cancer Screening and Treatment Outcomes from a Single Institution

“…This is similar to the trends reported by NCI SEER outcomes (45% radical prostatectomy, 24% total radiation, 8% hormonal, and 9% watchful waiting) 31 and within the regional trends reported by the Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR) Patterns of Care (PoC1) study. 32 Once prostate cancer was detected, we also observed a decrease in the age of surgery with successive decades, with the average age of surgical intervention as early as 63 years for the current decade and more conservative treatment likely for older age at cancer diagnosis. This trend has been observed elsewhere around the United States.…”

“…24,27,33 The PoC1 study also found that age at diagnosis affected the likely treatment choice, with older patients more likely to receive conservative treatment and younger individuals more likely to receive radical prostatectomies. 32 Single institution treatment trends, such as at Yale University, also reported a disparity in the ages of individuals receiving radical prostatectomy versus radiation implant treatment, with younger individuals receiving prostatectomy. 34 Comparing radical prostatectomy and radiation treatment outcomes was challenging, as we had few documented prostate cancer deaths in our population.…”

Racial disparities in prostate cancer care: Is adherence to National Comprehensive Cancer Network guidelines good enough for our patients?

“…[8][9][10][11] It has been demonstrated that AA race, being unmarried, and having public/no insurance are associated with receiving nondefinitive treatment; and, among those who do receive definitive therapy, AA race and being unmarried are associated with receiving RT over RP. 13 Overall survival, however, was associated with undergoing RP, younger age, and being married, among other factors. An additional consideration is whether all men with low-risk disease even require aggressive treatment.…”