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Platinum Priority – Prostate Cancer

Editorial by Stephen B. Williams and Brian F. Chapin on pp. 738–739 of this issue

Temporal Trends and the Impact of Race, Insurance,

and Socioeconomic Status in the Management of

Localized Prostate Cancer

Phillip J. Gray



, y


, * ,

Chun Chieh Lin



, y

, Matthew R. Cooperberg




Ahmedin Jemal






Jason A. Efstathiou



, z



The CHEM Center for Radiation Oncology, Hallmark Health




Center, Stoneham, MA, USA;



Surveillance & Health Services Research Program,

American Cancer Society, Atlanta, GA, USA;



Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San

Francisco, CA, USA;


Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 2 9 – 7 3 7

ava ilable at

journal homepage:

Article info

Article history:

Accepted August 22, 2016

Associate Editor:

Giacomo Novara


Prostate cancer


Androgen deprivation therapy

Practice patterns



Numerous management options exist for patients with prostate cancer;

however, recent trends and their influencing factors are not well described.


To describe modern patterns of care and factors associated withmanagement

choice using the National Cancer Database.

Design, setting, and participants:

Patients with localized prostate cancer diagnosed

between 2004 and 2012 were included and grouped according to National Comprehen-

sive Cancer Network guidelines into low, intermediate, or high risk.

Outcome measurements and statistical analysis:

Trend analyses and multivariate

logistic regression was used to identify factors associated with management.

Results and limitations:

There were 598 640 patients who met the study criteria; 36.3%

were classified as low risk, 43.8% intermediate risk, and 20.0% high risk. Over the study

period, among low-risk patients, observation increased from 9.2% to 21.3%, while radical

prostatectomy (RP) increased from 29.5% to 51.1% (



0.001 for both). In contrast,

external beam radiotherapy decreased from 24.3% to 14.5%, while brachytherapy

decreased from 31.7% to 11.1%. A similar pattern was seen for patients with intermedi-

ate-risk or high-risk disease. Among high-risk patients, RP increased from 25.1% to 43.4%

replacing external beam radiotherapy as the dominant therapy. On multivariate analy-

sis, racial minorities, the uninsured, and low-income patients were less likely to receive

RP. Low-risk patients in similar subgroups were significantly more likely to be observed.

Limitations include potential miscoding or misclassification of variables.


Patterns of care in localized prostate cancer are changing rapidly. While

use of observation is increasing in low-risk groups, the use of RP is increasing across all

risk groups with a concomitant decline in use of radiotherapy. Socioeconomic factors

appear to influence management choice.

Patient summary:

In this report we identify a recent significant increase in the use of

radical prostatectomy for prostate cancer patients. Socioeconomic factors such as race,

insurance type, and income may affect treatments offered to and received by patients.


2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.


These authors contributed equally as first authors.


These authors contributed equally as senior authors.

* Corresponding author. The CHEM Center for Radiation Oncology, Hallmark Health





48 Montvale Avenue, Stoneham, MA 02180, USA. Tel. +1-781-279-0655; Fax: +1-781-279-0409.

E-mail address:

(P.J. Gray).



2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.