Hospitalizations to Manage Complications of Modern Prostate Cancer Treatment in Older Men.

To assess rates of treatment-related hospitalizations following surgery and radiotherapy in the treatment of clinically-localized prostate cancer, given the importance of hospitalizations in health care resource utilization.

We conducted a population-based retrospective cohort study of patients aged 65-79 years receiving radical prostatectomy (open or minimally-invasive) or radiotherapy (brachytherapy or external beam) from 2001-2008 in the SEER-Medicare linked databases. We assessed treatment-related hospitalizations. We analysed the role of primary treatment on the number of complications per patient in each category using negative binomial regression.

Among 60,476 men, 14,492 underwent primary surgery and 45,984 underwent primary radiotherapy. Over a median follow-up of 5.6 years, the surgery group had significantly lower rates of hospital admissions (8.9 vs. 20.3/1000 person-years) than the radiation group. For both groups, admissions peaked within two years of treatment, but continued at a steady rate for 10 years. After adjustment for confounders, patients treated with radiation had higher incidence of hospital admissions (RR=1.8, 95% CI: 1.8-1.9,p<0.0001), compared to those having surgery. Stratified analysis showed an increased rate of hospitalizations of one day and two or more days (RR 3.1, 95% CI: 2.7-3.7 and RR 1.6, 95% CI 1.4-1.8, respectively) for patients treated with radiotherapy. The use of adjuvant/salvage therapies significantly increased rates of hospitalization. The results were robust to analysis using propensity-score matching.

Treatment-related hospitalizations are more common following radiotherapy than surgery in the treatment of clinically-localized prostate cancer. Limitations include a lack of treatment detail and residual confounding due to observational study design.

Urology. 2016 Jun 08 [Epub ahead of print]

Christopher J D Wallis, Alyson L Mahar, Patrick Cheung, Sender Herschorn, Raj Satkunasivam, Ashraf Al-Matar, Girish S Kulkarni, Yuna Lee, Ronald T Kodama, Steven A Narod, Robert K Nam

Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Division of Urology, University Health Network, University of Toronto., Department of Medicine, St. Michael's Hospital, University of Toronto., Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto., Department of Public Health Sciences, University of Toronto., Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto. Electronic address: .

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