Variances in patterns of care for patients with prostate cancer failing primary therapy

Variables that impact management of failed primary therapy for prostate cancer (CaP) are not well defined.

In the epub version of Cancer, Dr. Krupski and associates report on the patterns of secondary treatments in a large registry-based research study.

They sought to determine whether geographic region, ethnicity or socioeconomic status influences the receipt of secondary treatment.

The investigators used the Surveillance, Epidemiology and End Result (SEER) and Medicare databases for the years 1991 to 2001, identifying patients who were diagnosed before 1995. The SEER database tracks patients only for 4 months and lacks individual socioeconomic data. Linkage with Medicare claims permitted ascertainment of this data.

Patients undergoing primary treatment with radical prostatectomy (RP), radiotherapy (XRT), brachytherapy (BT), or combinations with androgen deprivation were identified. Androgen deprivation (AD) therapy alone was excluded. AD initiated 12 months or longer after RP was considered secondary therapy.

A cohort of 65,266 patients was studied, and 81-89% received no additional treatment. Some form of secondary treatment was given to 10,200 men. As patient age increased, the number receiving secondary treatment decreased. One-third of all patients requiring secondary therapy had Grade 3 tumors. Geographically, Los Angeles had surgical rates almost twice other regions and Detroit had XRT rates twice other regions. Secondary therapies varied almost 3-fold among SEER regions with the lowest rates in New Mexico and the highest in Detroit. The later the year of diagnosis the more likely the patients were to receive secondary therapy. Patients in Connecticut, Iowa and Los Angeles were more likely to receive secondary therapy and those in San Francisco and Seattle were less likely.

These data support that there a wide variation in regional administration of secondary treatment for CaP failure following primary therapy.

Written by Christopher P. Evans, MD - UroToday

Cancer 2006 Jun 16;epub