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with higher comorbidity (Charlson comorbidity index 1 and
2) were more likely to undergo surgery than radiotherapy.
Prior reports suggested that radiotherapy patients have
greater comorbidity than surgery patients, with greater risk
of perioperative complications and hospitalization
[13,14]. Whether the increased trend for surgery among
high-risk patients with greater comorbidity results in
oncologic superiority with acceptable perioperative mor-
bidity when compared to radiotherapy remains to be
determined. Equally, with increasing understanding of the
need for a multimodal approach to high-risk prostate
cancer, whether surgery was the initial step (before
adjuvant radiation and/or systemic therapy) and used to
provide pathologic drivers for selecting appropriate sec-
ondary therapies is unclear, and may account for the
increase in its utilization. Regardless of treatment, comor-
bidities and overall life expectancy should be taken into
consideration when deciding on treatment and need to be
discussed in the treatment decision-making process.
Lastly, racial/ethnic disparities in prostate cancer care
have previously been demonstrated. Moreover, the impact of
insurance and socioeconomic status on cancer care repre-
sents hallmarks for improvement in current health care
reform measures. The study findings have important
implications for current decision-making aimed at improv-
ing health care through the Affordable Care Act (ACA)
[15]. Over the next 10 yr, the ACA will bring in 37 million
newly insured individuals, many of whomhad limited access
to insurance, cancer diagnosis, and treatment options, as well
as those with more advanced cancer
[15]. Moreover, the ACA
provides significant consumer protections important to
oncology patients, such as coverage of pre-existing condi-
tions and mandated coinsurance limitations
[15]. Leveling
the access to care and minimizing the racial and socioeco-
nomic disparities that exist will need to be a priority when
evaluating the strategy of the ACA.
In conclusion, the authors present a temporal trend for
prostate cancer care in the USA that demonstrates greater
utilization of RP across all risk categories, which needs to be
interpreted in the context of the study design.
Conflicts of interest:
The authors have nothing to disclose.
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