Population-Based Assessment of Determining Treatments for Prostate Cancer | Cancer Screening, Prevention, Control | JAMA Oncology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.129.82. Please contact the publisher to request reinstatement.
1.
Siegel  R, Ma  J, Zou  Z, Jemal  A.  Cancer statistics, 2014.  CA Cancer J Clin. 2014;64(1):9-29.PubMedGoogle ScholarCrossref
2.
Makarov  DV, Trock  BJ, Humphreys  EB,  et al.  Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005.  Urology. 2007;69(6):1095-1101.PubMedGoogle ScholarCrossref
3.
Lu-Yao  GL, Albertsen  PC, Moore  DF,  et al.  Outcomes of localized prostate cancer following conservative management.  JAMA. 2009;302(11):1202-1209.PubMedGoogle ScholarCrossref
4.
Cooperberg  MR, Park  S, Carroll  PR.  Prostate cancer 2004: insights from national disease registries.  Oncology (Williston Park). 2004;18(10):1239-1247.PubMedGoogle Scholar
5.
Potosky  AL, Harlan  LC, Stanford  JL,  et al.  Prostate cancer practice patterns and quality of life: the Prostate Cancer Outcomes Study.  J Natl Cancer Inst. 1999;91(20):1719-1724.PubMedGoogle ScholarCrossref
6.
Hu  JC, Gu  X, Lipsitz  SR,  et al.  Comparative effectiveness of minimally invasive vs open radical prostatectomy.  JAMA. 2009;302(14):1557-1564.PubMedGoogle ScholarCrossref
7.
Nguyen  PL, Gu  X, Lipsitz  SR,  et al.  Cost implications of the rapid adoption of newer technologies for treating prostate cancer.  J Clin Oncol. 2011;29(12):1517-1524.PubMedGoogle ScholarCrossref
8.
Hayes  JH, Ollendorf  DA, Pearson  SD,  et al.  Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis.  JAMA. 2010;304(21):2373-2380.PubMedGoogle ScholarCrossref
9.
Bill-Axelson  A, Holmberg  L, Garmo  H,  et al.  Radical prostatectomy or watchful waiting in early prostate cancer.  N Engl J Med. 2014;370(10):932-942.PubMedGoogle ScholarCrossref
10.
Xu  J, Dailey  RK, Eggly  S, Neale  AV, Schwartz  KL.  Men’s perspectives on selecting their prostate cancer treatment.  J Natl Med Assoc. 2011;103(6):468-478.PubMedGoogle Scholar
11.
Schymura  MJ, Kahn  AR, German  RR,  et al.  Factors associated with initial treatment and survival for clinically localized prostate cancer: results from the CDC-NPCR Patterns of Care Study (PoC1).  BMC Cancer. 2010;10:152.PubMedGoogle ScholarCrossref
12.
Godtman  RA, Holmberg  E, Khatami  A, Stranne  J, Hugosson  J.  Outcome following active surveillance of men with screen-detected prostate cancer: results from the Göteborg randomised population-based prostate cancer screening trial.  Eur Urol. 2013;63(1):101-107.PubMedGoogle ScholarCrossref
13.
Loeb  S, Berglund  A, Stattin  P.  Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer.  J Urol. 2013;190(5):1742-1749.PubMedGoogle ScholarCrossref
14.
Mitchell  JM.  Urologists’ use of intensity-modulated radiation therapy for prostate cancer.  N Engl J Med. 2013;369(17):1629-1637.PubMedGoogle ScholarCrossref
15.
Sanda  MG, Dunn  RL, Michalski  J,  et al.  Quality of life and satisfaction with outcome among prostate-cancer survivors.  N Engl J Med. 2008;358(12):1250-1261.PubMedGoogle ScholarCrossref
16.
Pickles  T, Ruether  JD, Weir  L, Carlson  L, Jakulj  F; SCRN Communication Team.  Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance.  BJU Int. 2007;100(3):544-551.PubMedGoogle ScholarCrossref
17.
Warren  JL, Klabunde  CN, Schrag  D, Bach  PB, Riley  GF.  Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population.  Med Care. 2002;40(8)(suppl):IV-3-IV-18.PubMedGoogle Scholar
18.
D’Amico  AV, Whittington  R, Malkowicz  SB,  et al.  Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer.  JAMA. 1998;280(11):969-974.PubMedGoogle ScholarCrossref
19.
Bach  PB, Guadagnoli  E, Schrag  D, Schussler  N, Warren  JL.  Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations.  Med Care. 2002;40(8)(suppl):IV-19-IV-25.PubMedGoogle Scholar
20.
Browne  WJ, Subramanian  SV, Jones  K, Goldstein  H.  Variance partitioning in multilevel logistic models that exhibit overdispersion.  J R Stat Soc A. 2005;168(3):599-613.Google ScholarCrossref
21.
Daskivich  TJ, Chamie  K, Kwan  L,  et al.  Overtreatment of men with low-risk prostate cancer and significant comorbidity.  Cancer. 2011;117(10):2058-2066.PubMedGoogle ScholarCrossref
22.
Ganz  PA, Barry  JM, Burke  W,  et al.  National Institutes of Health State-of-the-Science Conference: role of active surveillance in the management of men with localized prostate cancer.  Ann Intern Med. 2012;156(8):591-595.PubMedGoogle ScholarCrossref
23.
Jang  TL, Yossepowitch  O, Bianco  FJ  Jr, Scardino  PT.  Low risk prostate cancer in men under age 65: the case for definitive treatment.  Urol Oncol. 2007;25(6):510-514.PubMedGoogle ScholarCrossref
24.
Grossfeld  GD, Chang  JJ, Broering  JM,  et al.  Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the Cancer of the Prostate Strategic Urologic Research Endeavor database.  J Urol. 2001;165(3):851-856.PubMedGoogle ScholarCrossref
25.
Levin  DC, Rao  VM, Parker  L, Frangos  AJ, Sunshine  JH.  Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral.  J Am Coll Radiol. 2008;5(12):1206-1209.PubMedGoogle ScholarCrossref
26.
Mitchell  JM, Sunshine  JH.  Consequences of physicians’ ownership of health care facilities: joint ventures in radiation therapy.  N Engl J Med. 1992;327(21):1497-1501.PubMedGoogle ScholarCrossref
27.
Bekelman  JE, Suneja  G, Guzzo  T, Pollack  CE, Armstrong  K, Epstein  AJ.  Effect of practice integration between urologists and radiation oncologists on prostate cancer treatment patterns.  J Urol. 2013;190(1):97-101.PubMedGoogle ScholarCrossref
28.
Shahinian  VB, Kuo  YF, Gilbert  SM.  Reimbursement policy and androgen-deprivation therapy for prostate cancer.  N Engl J Med. 2010;363(19):1822-1832.PubMedGoogle ScholarCrossref
29.
Cooperberg  MR, Broering  JM, Carroll  PR.  Time trends and local variation in primary treatment of localized prostate cancer.  J Clin Oncol. 2010;28(7):1117-1123.PubMedGoogle ScholarCrossref
30.
Wilt  TJ, MacDonald  R, Rutks  I, Shamliyan  TA, Taylor  BC, Kane  RL.  Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer.  Ann Intern Med. 2008;148(6):435-448.PubMedGoogle ScholarCrossref
31.
Jacobs  BL, Zhang  Y, Schroeck  FR,  et al.  Use of advanced treatment technologies among men at low risk of dying from prostate cancer.  JAMA. 2013;309(24):2587-2595.PubMedGoogle ScholarCrossref
32.
Thompson  IM, Ankerst  DP, Chi  C,  et al.  Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial.  J Natl Cancer Inst. 2006;98(8):529-534.PubMedGoogle ScholarCrossref
33.
Scosyrev  E, Messing  EM, Mohile  S, Golijanin  D, Wu  G.  Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality.  Cancer. 2012;118(12):3062-3070.PubMedGoogle ScholarCrossref
Original Investigation
April 2015

Population-Based Assessment of Determining Treatments for Prostate Cancer

Author Affiliations
  • 1Department of Urology, David Geffen School of Medicine at University of California, Los Angeles
  • 2Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
JAMA Oncol. 2015;1(1):60-67. doi:10.1001/jamaoncol.2014.192
Abstract

Importance  Many men with indolent prostate cancer often opt for radical prostatectomy or radiotherapy treatment for their disease. These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments. Without a better understanding of the mutable agents and predictors of treatment types, diffusion of expectant management among these men will be slow.

Objective  To determine population-based predictors for treatment and use of watchful waiting or active surveillance for indolent prostate cancer.

Design, Setting, and Participants  We used Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. A total of 37 621 men in the general community diagnosed as having prostate cancer from 2004 to 2007 were followed until December 31, 2009.

Exposures  Watchful waiting or active surveillance, radiation therapy, or radical prostatectomy.

Main Outcomes and Measures  We used mixed-effects logistic regression analysis to determine the factors associated with aggressive treatment and use of watchful waiting or active surveillance for men with prostate cancer.

Results  The most common treatment type is radiation therapy (57.9% [95% CI, 57.4%-58.4%]), followed by radical prostatectomy (19.1% [95% CI, 18.7%-19.5%]) and watchful waiting or active surveillance (9.6% [95% CI, 9.3%-9.9%]). Moreover, patients and providers significantly integrate age (odds ratio [OR], 0.32 [95% CI, 0.29–0.35]) and comorbidities (OR, 0.62 [95% CI, 0.56–0.68]) when determining radical prostatectomy, while regional variation (OR, 0.57 [95% CI, 0.47–0.68]) and referral patterns (OR, 44.46 [95% CI, 41.04–48.17]) influence the use of radiation therapy. Patient demographics and tumor characteristics significantly account for 40% of patients undergoing prostatectomy, 12% choosing watchful waiting or active surveillance, and only 3% undergoing radiotherapy.

Conclusions and Relevance  There is increased use of radiotherapy among patients with indolent prostate cancer with limited to no correlation with tumor biology. Active surveillance was underused, and a significant proportion of the variance was unexplained. Further research into qualitatively describing the contributing factors that drive decision-making recommendations for prostate cancer patients is needed.

×