Significant increase in prostatectomy and decrease in radiation for clinical T3 prostate cancer from 1998 to 2012.
PURPOSE
We aimed to describe changes in treatment patterns for clinical T3 prostate cancer (PCa) from 1998 to 2012, specifically investigating what factors influence receipt of prostatectomy or radiation.


MATERIALS AND METHODS
Using the Surveillance, Epidemiology, and End Results database, we studied 11,604 men with clinical T3N0M0 PCa from 1998 to 2012, with treatment categorized as radiation, radical prostatectomy (RP), or no curative therapy. We calculated rate of treatment type by year of diagnosis to investigate trends in treatment patterns, further stratifying by clinical T3a, defined as unilateral and bilateral extracapsular extension (n = 3,842), vs. T3b (defined as extension to seminal vesicles (n = 3,665). Finally, a multivariable logistic regression analysis measured association of demographic and clinical variables with type of treatment received for years 2010 to 2011.


RESULTS
Rates of prostatectomy increased significantly from 1998 to 2012 (12.5% vs. 44.4%), radiation decreased significantly (55.8% vs. 38.4%), and receipt of no treatment also decreased (31.7% vs. 17.2%, all P<0.001). These trends were similar for clinical T3a and T3b. Rates of prostatectomy surpassed radiation by 2008 in clinical T3a, reaching 49.8% vs. 37.1%, respectively, in 2012 (P = 0.002), and were statistically similar to radiation in 2012 for clinical T3b, reaching 41.6% vs. 42.1% (P = 0.92). Multivariable logistic regression analysis demonstrated that patients were less likely to receive prostatectomy than radiation if biopsy Gleason scores of 8 to 10 (adjusted odds ratio [AOR] = 0.41, 0.32-0.53), higher initial prostate-specific antigen (AOR = 0.97, 0.97-0.98), and older age (AOR = 0.92, 0.90-0.03, all P<0.01). The likelihood of RP was similar among cT3b vs. cT3a (AOR = 0.95, 0.71-1.26, P = 0.74).


CONCLUSIONS
Since 1998, there has been a significant increase in the use of RP for clinical T3 PCa and a significant decrease in the use of radiation such that in 2012, the use of prostatectomy exceeded the use of radiation.
['Nezolosky|Michelle D|MD|', 'Dinh|Kathryn T|KT|', 'Muralidhar|Vinayak|V|', 'Mahal|Brandon A|BA|', 'Chen|Yu-Wei|YW|', 'Beard|Clair J|CJ|', 'Choueiri|Toni K|TK|', 'Martin|Neil E|NE|', 'Sweeney|Christopher J|CJ|', 'Trinh|Quoc-Dien|QD|', 'Nguyen|Paul L|PL|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D049673:History, 20th Century D049674:History, 21st Century D006801:Humans D008297:Male D008875:Middle Aged D060787:Neoplasm Grading D009367:Neoplasm Staging D011468:Prostatectomy D011471:Prostatic Neoplasms
Prostatectomy Prostate cancer Treatment patterns Clinical T3 disease Radiation therapy