To describe the national-level patterns of care for local ablative therapy among men with PCa and identify patient- and hospital-level factors associated with the receipt of these techniques.
We retrospectively interrogated the National Cancer Database (NCDB) for men with clinically localized PCa between 2010 and 2017.
The main outcome was receipt of local tumor ablation with either cryo- or laser-ablation, and "other method of local tumor destruction including high-intensity focused ultrasound (HIFU)". Patient level, hospital level, and demographic variables were collected. Mixed effect logistic regression models were fitted to identify separately patient- and hospital-level predictors of receipt of local ablative therapy.
Overall, 11,278 patients received ablative therapy, of whom 78.8% had cryotherapy, 15.6% had laser, and 5.7% had another method including HIFU. At the patient level, men with intermediate-risk PCa were more likely to be treated with local ablative therapy (OR 1.05; 95% CI 1.00-1.11; p = 0.05), as were men with Charlson Comorbidity Index > 1 (OR 1.36; 95% CI 1.29-1.43; p < 0.01), men between 71 and 80 years (OR 3.70; 95% CI 3.43-3.99; p < 0.01), men with Medicare insurance (OR 1.38; 95% 1.31-1.46; p < 0.01), and an income < $47,999 (OR 1.16; 95% CI 1.06-1.21; p < 0.01). At the hospital-level, local ablative therapy was less likely to be performed in academic/research facilities (OR 0.45; 95% CI 0.32-0.64; p < 0.01).
Local ablative therapy for PCa treatment is more commonly offered among older and comorbid patients. Future studies should investigate the uptake of these technologies in non-hospital-based settings and in light of recent changes in insurance coverage.
World journal of urology. 2023 Mar 17 [Epub ahead of print]
Mara Koelker, Muhieddine Labban, Nicola Frego, Christian P Meyer, Georg Salomon, Stuart R Lipsitz, John Withington, Caroline M Moore, Clare M Tempany, Kemal Tuncali, Arvin George, Adam S Kibel, Quoc-Dien Trinh, Alexander P Cole
Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA., Department of Urology, Ruhr University Bochum, Klinikum Herford, Herford, Germany., Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Division of Surgical and Interventional Science, University College London, London, UK., Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Department of Urology, University of Michigan, Ann Arbor, MI, USA., Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA. .