UPJ Insight: Facility-Level Variation in Use of Locoregional Therapy for Metastatic Prostate Cancer
By: Matthew Buck, BS; Frank H. Netter MD; Eric Ghiraldi, DO; Patrick Demkowicz, BS; Henry S. Park, MPH, MD; Yi An, MD; Benjamin H. Kann, MD; James B. Yu, MHS, MD; Preston C. Sprenkle, MD; Isaac Y. Kim, MD, PhD; Michael S. Leapman, MD | Posted on: 01 Apr 2022
Buck M, Ghiraldi E, Demkowicz P et al: Facility-level variation in use of locoregional therapy for metastatic prostate cancer. Urol Pract 2021; https://doi.org/10.1097/UPJ.0000000000000290.
Study Need and Importance
The treatment paradigm for patients with metastatic prostate cancer is evolving, with level 1 evidence supporting radiation therapy to the prostate and multiple ongoing trials (SIMCAP, SWOG 1082 and others) investigating the role of radical prostatectomy. Prior to the availability of evidence, these locoregional treatments to the prostate in the metastatic patient have enjoyed widespread use, and there is a need to contextualize both patient and facility level factors associated with treatment.
What We Found
We identified 35,933 patients in the National Cancer Database with metastatic prostate cancer who underwent locoregional therapy to the prostate with either radiotherapy or radical prostatectomy. We found that the majority of locoregional treatments were delivered by a small group of facilities nationwide and were associated with patient clinical and demographic factors. Facilities that made greater use of locoregional therapy were large-volume community centers and varied by facility geographic region.
The study is limited by its observational design. Importantly, we were not able to identify the number of metastases at diagnosis for each patient, shown to be important in the STAMPEDE and HORRAD trials, although ongoing trials in radical prostatectomy consider a range of metastases at diagnosis. Furthermore, we were not able to account for practitioner-level practices, which may influence treatment choice.
Interpretation for Patient Care
As evidence for the role of radical prostatectomy in the treatment of metastatic prostate cancer accumulates, drivers of treatment decisions in the period before evidence availability can contextualize expected increases in therapy utilization. As local treatment is likely to increase among patients with M1 prostate cancer, further study can help clarify how ingrained patterns of care at the facility-level influence the treatment decisions.