Factors associated with initial treatment and survival for clinically localized prostate cancer: Results from the CDC-NPCR Patterns of Care Study (PoC1)

Maria J. Schymura, Amy R. Kahn, Robert R. German, Mei Chin Hsieh, Rosemary D Cress, Jack L. Finch, John P. Fulton, Tiefu Shen, Erik Stuckart

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Abstract

Background: Despite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival.Methods: The analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively.Results: Patients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7%), radiation therapy (31.4%), hormone therapy (10.3%), or watchful waiting (18.6%). After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting): older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4), comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy), older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black race in patients under 60 years of age, were associated with receipt of radiation therapy. Overall survival was related to younger age, being married, Gleason score under 8, radical prostatectomy, and state of residence. Comorbidity was only associated with risk of death within the first three years of diagnosis.Conclusions: In the absence of clear-cut evidence favoring one treatment modality over another, it is important to understand the factors that inform treatment selection. Since state of residence was a significant predictor of both treatment as well as overall survival, true regional differences probably exist in how physicians and patients select treatment options. Factors affecting treatment choice and treatment effectiveness need to be further explored in future population-based studies.

Original languageEnglish (US)
Article number152
JournalBMC Cancer
Volume10
DOIs
StatePublished - Apr 19 2010
Externally publishedYes

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Centers for Disease Control and Prevention (U.S.)
Prostatic Neoplasms
Survival
Watchful Waiting
Therapeutics
Prostatectomy
Neoplasm Grading
Radiotherapy
Hormones
Comorbidity
Medical Record Linkage
Social Adjustment
Vital Statistics
Censuses
Insurance
Proportional Hazards Models
Population
Medical Records

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Genetics

Cite this

Factors associated with initial treatment and survival for clinically localized prostate cancer : Results from the CDC-NPCR Patterns of Care Study (PoC1). / Schymura, Maria J.; Kahn, Amy R.; German, Robert R.; Hsieh, Mei Chin; Cress, Rosemary D; Finch, Jack L.; Fulton, John P.; Shen, Tiefu; Stuckart, Erik.

In: BMC Cancer, Vol. 10, 152, 19.04.2010.

Research output: Contribution to journalArticle

Schymura, Maria J. ; Kahn, Amy R. ; German, Robert R. ; Hsieh, Mei Chin ; Cress, Rosemary D ; Finch, Jack L. ; Fulton, John P. ; Shen, Tiefu ; Stuckart, Erik. / Factors associated with initial treatment and survival for clinically localized prostate cancer : Results from the CDC-NPCR Patterns of Care Study (PoC1). In: BMC Cancer. 2010 ; Vol. 10.
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abstract = "Background: Despite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival.Methods: The analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively.Results: Patients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7{\%}), radiation therapy (31.4{\%}), hormone therapy (10.3{\%}), or watchful waiting (18.6{\%}). After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting): older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4), comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy), older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black race in patients under 60 years of age, were associated with receipt of radiation therapy. Overall survival was related to younger age, being married, Gleason score under 8, radical prostatectomy, and state of residence. Comorbidity was only associated with risk of death within the first three years of diagnosis.Conclusions: In the absence of clear-cut evidence favoring one treatment modality over another, it is important to understand the factors that inform treatment selection. Since state of residence was a significant predictor of both treatment as well as overall survival, true regional differences probably exist in how physicians and patients select treatment options. Factors affecting treatment choice and treatment effectiveness need to be further explored in future population-based studies.",
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T2 - Results from the CDC-NPCR Patterns of Care Study (PoC1)

AU - Schymura, Maria J.

AU - Kahn, Amy R.

AU - German, Robert R.

AU - Hsieh, Mei Chin

AU - Cress, Rosemary D

AU - Finch, Jack L.

AU - Fulton, John P.

AU - Shen, Tiefu

AU - Stuckart, Erik

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N2 - Background: Despite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival.Methods: The analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively.Results: Patients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7%), radiation therapy (31.4%), hormone therapy (10.3%), or watchful waiting (18.6%). After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting): older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4), comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy), older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black race in patients under 60 years of age, were associated with receipt of radiation therapy. Overall survival was related to younger age, being married, Gleason score under 8, radical prostatectomy, and state of residence. Comorbidity was only associated with risk of death within the first three years of diagnosis.Conclusions: In the absence of clear-cut evidence favoring one treatment modality over another, it is important to understand the factors that inform treatment selection. Since state of residence was a significant predictor of both treatment as well as overall survival, true regional differences probably exist in how physicians and patients select treatment options. Factors affecting treatment choice and treatment effectiveness need to be further explored in future population-based studies.

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