Use of Advanced Treatment Technologies Among Men at Low Risk of Dying From Prostate Cancer

• Published in: JAMA : the journal of the American Medical Association 2013-06, Vol.309 (24), p.2587-2595
• Main Authors: Jacobs, Bruce L, Zhang, Yun, Schroeck, Florian R, Skolarus, Ted A, Wei, John T, Montie, James E, Gilbert, Scott M, Strope, Seth A, Dunn, Rodney L, Miller, David C, Hollenbeck, Brent K
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; General aspects; Gynecology. Andrology. Obstetrics; Humans; Life Expectancy; Male; Male genital diseases; Males; Medical sciences; Medical treatment; Medicare - statistics & numerical data; Mens health; Mortality; Nephrology. Urinary tract diseases; Prognosis; Prostate cancer; Prostatectomy - statistics & numerical data; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy, Intensity-Modulated - statistics & numerical data; Retrospective Studies; Risk; SEER Program; Tumors; Tumors of the urinary system; United States - epidemiology; Urinary tract. Prostate gland; Watchful Waiting
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2013.6882

IMPORTANCE The use of advanced treatment technologies (ie, intensity-modulated radiotherapy [IMRT] and robotic prostatectomy) for prostate cancer is increasing. The extent to which these advanced treatment technologies have disseminated among patients at low risk of dying from prostate cancer is uncertain. OBJECTIVE To assess the use of advanced treatment technologies, compared with prior standards (ie, traditional external beam radiation treatment [EBRT] and open radical prostatectomy) and observation, among men with a low risk of dying from prostate cancer. DESIGN, SETTING, AND PATIENTS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified a retrospective cohort of men diagnosed with prostate cancer between 2004 and 2009 who underwent IMRT (n = 23 633), EBRT (n = 3926), robotic prostatectomy (n = 5881), open radical prostatectomy (n = 6123), or observation (n = 16 384). Follow-up data were available through December 31, 2010. MAIN OUTCOMES AND MEASURES The use of advanced treatment technologies among men unlikely to die from prostate cancer, as assessed by low-risk disease (clinical stage ≤T2a, biopsy Gleason score ≤6, and prostate-specific antigen level ≤10 ng/mL), high risk of noncancer mortality (based on the predicted probability of death within 10 years in the absence of a cancer diagnosis), or both. RESULTS In our cohort, the use of advanced treatment technologies increased from 32% (95% CI, 30%-33%) to 44% (95% CI, 43%-46%) among men with low-risk disease (P