Variation in surgical treatment patterns for patients with prostate cancer in the United States: Do patients in academic hospitals fare better?

With prostate cancer (CaP) screening, overtreatment of low-risk CaP remains a concern. We investigated the patterns of radical prostatectomy (RP) for pathologic insignificant (iCaP) and significant CaP (sCaP) as well as variations between academic and nonacademic hospitals.

Patients undergoing RP for clinical T1c CaP were identified in the National Cancer Database between 2006 and 2013. The primary outcome was the trend of RP for insignificant prostate cancer (iCaP) and significant prostate cancer (sCaP) over the study period. The secondary outcome was to compare the RP rate in academic vs. nonacademic institutions. Univariable and multivariable analysis were utilized to evaluate the association between overtreatment and practice type. iCaP was defined as organ confined CaP with Gleason Score ≤6.

The total number of RP increased from 17,970 cases in 2006 to 25,324 in 2013. The RP rate decreased for iCaP from 39.9% to 19.8%, while increasing for sCaP from 18% to 27% over the study period. Patients undergoing RP in academic settings were less likely to have iCaP (odds ratio 0.88, 95% confidence interval 0.80-0.97). Caucasian race, private insurance, younger age, and treatment in the Eastern United States were associated with higher rates of iCaP at RP.

The rate of iCaP has declined over time in the United States for patients undergoing RP. Although RP in nonacademic setting was more likely to have iCaP on surgical pathology, this trend has been downward among practice types. Treatment appropriateness is an underrecognized, undermeasured, but increasingly important component of the high-value care discussion that warrants greater attention.

Urologic oncology. 2018 Nov 13 [Epub ahead of print]

Aydin Pooli, Amirali Salmasi, Izak Faiena, Andrew T Lenis, David C Johnson, Cedric Lebacle, Alexandra Drakaki, Kiran Gollapudi, Jeremy Blumberg, Allan J Pantuck, Karim Chamie

Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: ., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Bicetre University Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, University Paris, Saclay Le Kremlin, Bicetre, France., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA., Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA.

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