Related Experiment Video
Updated: May 29, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Utilization of Radical Prostatectomy Versus Radiation Therapy for Gleason Grade Group 5 Prostate Cancer Before and
H Scott McGinnis1, Taylor Corriher1, James Janopaul-Naylor1,2
1Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
Objectives:
The 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening has resulted in a shift to higher-stage prostate cancer (PC) at diagnosis. We evaluate the utilization of radical prostatectomy (RP) versus radiation therapy (RT) in the US for Gleason grade group 5 (GG5) prostate cancer before and after 2012.
Methods:
We identified 34,011 men with localized GG5 PC undergoing primary therapy with (1) RP or (2) RT + androgen deprivation therapy (ADT) between 2004 and 2017 from the National Cancer Database. The chi-square test was used to compare the relative use of RP and RT before versus after 2012. Annual use of RP versus RT from 2004 to 2017 was compared using Cochran-Armitage test for trend. We modeled the effect of treatment year on the use of RP using multivariable logistic regression.
Results:
Across all centers, the use of RP increased from 31% to 41% (p for trend < 0.001). 2012 was associated with significant inflection for increase in RP use in all centers. There was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28-1.40, p < 0.001).
Conclusions:
Utilization of RP for GG5 PC has significantly increased in the United States over the past decade. It remains unknown if outcomes may be compromised in this group of high-risk men, many of whom require post-prostatectomy RT and/or ADT. Prospective comparison of RP versus RT + ADT for GG5 PC are needed to determine optimal treatment for these patients.
