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Clinical Research

Nationally representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America project

Prostate Cancer and Prostatic Diseases volume 18, pages 149–154 (2015)Cite this article

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Abstract

Background:

Several treatment options for clinically localized prostate cancer currently exist under the established guidelines. We aim to assess nationally representative trends in treatment over time and determine potential geographic variation using two large national claims registries.

Methods:

Men with prostate cancer insured by Medicare (1998–2006) or a private insurer (Ingenix database, 2002–2006) were identified using International Classification of Diseases-9 and Current Procedural Terminology-4 codes. Geographic variation and trends in the type of treatment utilized over time were assessed. Geographic data were mapped using the GeoCommons online mapping platform. Predictors of any treatment were determined using a hierarchical generalized linear mixed model using the logit link function.

Results:

The use of radical prostatectomy increased, 33–48%, in the privately insured i3 database while remaining stable at 12% in the Medicare population. There was a rapid uptake in the use of newer technologies over time in both the Medicare and i3 cohorts. The use of laparoscopic-assisted prostatectomy increased from 1% in 2002 to 41% in 2006 in i3 patients, whereas the incidence increased from 3% in 2002 to 35% in 2006 for Medicare patients. The use of neoadjuvant/adjuvant androgen deprivation therapy was lower in the i3 cohort and has decreased over time in both i3 and Medicare. Physician density had an impact on the type of primary treatment received in the New England region; however, this trend was not seen in the western or southern regions of the United States.

Conclusions:

Using two large national claims registries, we have demonstrated trends over time and substantial geographic variation in the type of primary treatment used for localized prostate cancer. Specifically, there has been a large increase in the use of newer technologies (that is, laparoscopic-assisted prostatectomy and intensity-modulated radiation therapy). These results elucidate the need for improved data collection on prostate cancer treatment outcomes to reduce unwarranted variation in care.

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References

  1. Siegel R, Naishadham D, Jemal A . Cancer statistics, 2013. CA Cancer J Clin 2013; 63: 11–30.

    Article  PubMed  Google Scholar 

  2. Thompson IM, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177: 2106–2131.

    Article  PubMed  Google Scholar 

  3. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011; 59: 61–71.

    Article  PubMed  Google Scholar 

  4. Cooperberg MR, Broering JM, Carroll PR . Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 2010; 28: 1117–1123.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS . Determinants of androgen deprivation therapy use for prostate cancer: role of the urologist. J Natl Cancer Inst 2006; 98: 839–845.

    Article  PubMed  Google Scholar 

  6. Nambudiri VE, Landrum MB, Lamont EB, McNeil BJ, Bozeman SR, Freedland SJ et al. Understanding variation in primary prostate cancer treatment within the Veterans Health Administration. Urology 2012; 79: 537–545.

    Article  PubMed  Google Scholar 

  7. Kawachi MH . Counterpoint: robot-assisted laparoscopic prostatectomy: perhaps the surgical gold standard for prostate cancer care. J Natl Compr Canc Netw 2007; 5: 689–692.

    Article  PubMed  Google Scholar 

  8. Bechis SK, Carroll PR, Cooperberg MR . Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 2011; 29: 235–241.

    Article  PubMed  Google Scholar 

  9. Sun L, Caire AA, Robertson CN, George DJ, Polascik TJ, Maloney KE et al. Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras. J Urol 2009; 182: 2242–2248.

    Article  CAS  PubMed  Google Scholar 

  10. Herr HW, O'Sullivan M . Quality of life of asymptomatic men with nonmetastatic prostate cancer on androgen deprivation therapy. J Urol 2000; 163: 1743–1746.

    Article  CAS  PubMed  Google Scholar 

  11. Newton C, Slota D, Yuzpe AA, Tummon IS . Memory complaints associated with the use of gonadotropin-releasing hormone agonists: a preliminary study. Fertil Steril 1996; 65: 1253–1255.

    Article  CAS  PubMed  Google Scholar 

  12. Shahinian VB, Kuo Y-F, Freeman JL, Goodwin JS . Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 2005; 352: 154–164.

    Article  CAS  PubMed  Google Scholar 

  13. Keating NL, O'Malley AJ, Smith MR . Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 2006; 24: 4448–4456.

    Article  CAS  PubMed  Google Scholar 

  14. Cookson MS, Sogani PC, Russo P . Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study. BJU Int 1997; 79: 432–438.

    Article  CAS  Google Scholar 

  15. Krahn M, Bremner KE, Tomlinson G, Luo J, Ritvo P, Naglie G et al. Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use? BJU Int 2011; 108: 1588–1596.

    Article  CAS  PubMed  Google Scholar 

  16. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 1997; 337: 295–300.

    Article  CAS  PubMed  Google Scholar 

  17. D'Amico AV, Manola J, Loffredo M . 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer. JAMA 2004; 292: 821–827.

    Article  CAS  PubMed  Google Scholar 

  18. Cooperberg MR, Cowan J, Broering JM, Carroll PR . High-risk prostate cancer in the United States, 1990-2007. World J Urol 2008; 26: 211–218.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Krupski TL, Kwan L, Afifi AA, Litwin MS . Geographic and socioeconomic variation in the treatment of prostate cancer. J Clin Oncol 2005; 23: 7881–7888.

    Article  PubMed  Google Scholar 

  20. Kramer KM, Bennett CL, Pickard AS, Lyons EA, Wolf MS, McKoy JM et al. Patient preferences in prostate cancer: a clinician's guide to understanding health utilities. Clin Prostate Cancer 2005; 4: 15–23.

    Article  PubMed  Google Scholar 

  21. Kapoor DA, Zimberg SH, Ohrin LM, Underwood W 3rd, Olsson CA . Utilization trends in prostate cancer therapy. J Urol 2011; 186: 860–864.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (HHSN276201200016C; to MSL).

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Authors and Affiliations

  1. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA

    K C Cary

  2. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA

    S Punnen

  3. Department of Urology, University of California, San Francisco, San Francisco, CA, USA

    A Y Odisho & M R Cooperberg

  4. Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA

    M S Litwin & C S Saigal

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  1. K C Cary
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and the NIDDK Urologic Diseases in America Project

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Correspondence to K C Cary.

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Competing interests

MRC is a consultant for Genomic Health, Myriad, GenomeDx, Dendreon, Eli Lilly, Abbott Labs, Janssen and Amgen. CSS is a cofounder of Wiser Care LLC. The remaining authors declare no conflict of interest.

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Cary, K., Punnen, S., Odisho, A. et al. Nationally representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America project. Prostate Cancer Prostatic Dis 18, 149–154 (2015). https://doi.org/10.1038/pcan.2015.3

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