Update on Trends in Initial Management of High-Risk Prostate Cancer
Posted: Monday, October 12, 2020
In recent years, the rate of prostatectomy in managing high-risk prostate cancer has nearly doubled, according to a large retrospective analysis published in JAMA Network Open. Over the same period, the use of radiotherapy has declined. “The increasing use of robotic approaches suggests urologists and patients may regard prostatectomies safer than previous techniques,” stated Himanshu Nagar, MD, of Weill Cornell Medicine, New York, and colleagues. “Conversely, a decrease in radiotherapy may reflect reluctance toward recommended androgen-deprivation therapy with radiotherapy.”
A total of 214,972 men in the National Cancer Database from 2004 to 2016 were identified as having high-risk prostate cancer—defined as clinical stage T3 or T4, a prostate-specific antigen level higher than 20 ng/mL, or a Gleason score of 8 to 10. Of those with high-risk disease, 75,847 underwent prostatectomy, and 104,635 underwent radiotherapy.
The proportional rates of high-risk prostate cancer increased from 11.8% to 20.4% (P < .001). From 2004 to 2016, the proportion of men undergoing prostatectomy increased from 22.8% to 40.5% (P < .001). During the same period, the rates of radiotherapy decreased from 59.7% to 43.3% (P < .001). The odds of undergoing prostatectomy increased from 2004 to 2013 and remained consistent through 2016 (P < .001).
Having private insurance increased the odds of prostatectomy; higher income, education, and treatment at an academic facility were found to be associated with the use of robotic prostatectomy. In contrast, a higher Gleason score, disease stage, prostate-specific antigen levels, age, and living in a rural area all reduced the odds of undergoing surgery. Although Black men were less likely than White men to undergo a prostatectomy, the authors suggest this gap has improved over time.
Disclosure: The study authors reported no conflicts of interest.