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Facility-Level Variation in Use of Locoregional Therapy for Metastatic Prostate Cancer
Matthew Buck1,2, Eric Ghiraldi1, Patrick Demkowicz3
1Department of Urology, Yale School of Medicine, New Haven, Connecticut.
Urology Practice
|May 5, 2023
Summary
Locoregional therapy for metastatic prostate cancer was uncommon before guidelines supported its use, with significant variation in facility-level treatment rates. Patient factors like insurance and comorbidity, and facility type influenced treatment decisions.
Area of Science:
- Oncology
- Urology
- Health Services Research
Background:
- Locoregional therapy (LRT) for newly diagnosed metastatic prostate cancer (M1) lacked evidence before 2017.
- Understanding patient and institutional factors influencing LRT use is crucial for future practice.
Purpose of the Study:
- To identify patient- and institution-level factors associated with LRT use in M1 prostate cancer patients before guideline support.
- To characterize trends in facility-level LRT utilization.
Main Methods:
- Analysis of the National Cancer Database (2004-2017) for M1 prostate adenocarcinoma patients.
- Multilevel logistic regression to assess patient factors and facility-level utilization.
- Examination of institutional characteristics of high-LRT-utilizing facilities.
Main Results:
- 11.5% of 35,933 M1 prostate cancer patients received LRT (radiation or prostatectomy).
- LRT use was concentrated in a small subset of facilities (14%).
- Uninsured status and high comorbidity were linked to lower LRT odds; community centers and specific regions showed higher utilization.
Conclusions:
- LRT use in M1 prostate cancer varied significantly by facility before guideline support.
- A small number of high-utilizing facilities drove overall LRT rates.
- Findings provide context for anticipated increases in LRT use for M1 prostate cancer.
