Patients with localized prostate cancer who had undergone radical prostatectomy between 2012-2016 at one of 27 practices participating in MUSIC were identified. For the purpose of this analysis, patients with post-operative biochemical recurrence (defined herein as at least 1 post-operative PSA >=0.1ng/mL) were selected. Logistic regression models were used to identify associations between patient demographic and pathologic characteristics and the receipt of SRT.
1017 eligible patients who experienced biochemical recurrence following radical prostatectomy were identified. Of these, 29.7% underwent SRT, at varying levels of PSA: 16.7% at 0.1-0.5, 5.2% at 0.5-1.0, 3.3% at 1.0-2.0, and 4.5% at 2.0 ng/mL or higher. After accounting for patient and practice level factors, patients with higher post-RP PSA, those with positive surgical margins, those with higher T-stage, and those with higher pathological grade were more likely to receive SRT, as might be expected. Interestingly, even after accounting for patient demographic and tumor characteristics, there was significant variation in the utilization of SRT, ranging from 3.5% to 74%. This appeared to be driven by a practice-level philosophy regarding SRT, rather than patient-level factors.
The authors identify significant variation in practice-level utilization of SRT, which cannot be explained by either patient demographics or tumor characteristics. This is not necessarily surprising given the scientific uncertainty regarding the optimal approach to post-operative radiotherapy.
Presented By: Scott Hawken
Co-authors: Daniel E Spratt, Ji Qi, Susan M Linsell, Michael L Cher, Kurshid R Ghani, David C Miller, James E Montie, Todd M Morgan, for the Michigan Urological Surgery Improvement Collaborative
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA