Residential location shapes initial prostate cancer care in Korea (2010-2020): A nationwide stage- and...

To characterize nationwide patterns of initial prostate cancer (PCa) management in Korea from 2010 to 2020, stratified by clinical stage, risk, and residential context.

We performed a secondary analysis of a chart-abstracted cohort from 51 general hospitals. Initial treatment was classified into ten mutually exclusive categories (active surveillance; surgery; surgery after androgen deprivation therapy [ADT]; radiotherapy; radiotherapy after ADT; docetaxel after ADT; androgen receptor-targeted agent [ARTA] after ADT; ADT-only ≥1 year; other active treatment; unknown). Localized disease (T1-T4N0M0) was stratified by risk (low, intermediate, and high). Residential context was coded as capital versus non-capital and urban versus rural. National Comprehensive Cancer Network risk stratification (version 2.2024) was applied uniformly across survey years.

Among 27,075 men, initial management differed significantly by stage, risk, and residence. In localized disease, surgery predominated, active surveillance was most frequent in low-risk disease, and radiotherapy and ADT-only increased with higher risk (p<0.001). Over time, ADT-only decreased in metastatic disease, with increases in radiotherapy and systemic intensification (p=0.004). Capital and urban residence were associated with greater use of surgery in localized disease and systemic intensification in metastatic disease, whereas non-capital and rural residence relied more on ADT-only (all p<0.001). In multivariable analyses, residential context remained independently associated with treatment selection after adjustment for age, prostate-specific antigen, grade, and stage.

Initial PCa management in Korea during the 2010s reflected contemporary adoption of surgical and systemic therapies but demonstrated persistent geographic variation, indicating residential context influences real-world access to guideline-concordant care.