Login to Access Video or Poster Abstract: MP43-08
Sources of Funding: none

Introduction

Management of localized prostate cancer (PCa) is not uniform. There continues to be underutilization of non-definitive management (NDM) in low risk PCa and often an absence of hormonal ablative therapy (HT) in addition to external beam radiotherapy (EBRT) given to high risk patients. We attempted to identify the impact of facility volume (FV) stratification on the management strategies of low and high risk PCa.

Methods

We utilized the National Cancer Database (NCDB) and 344,107 patients diagnosed with localized PCa from 2010-2013 had data available for review. We analyzed two groups of patients: Group (1) included 105,295 patients with NCCN low risk PCa and Group (2) included 60,255 patients with High Risk (Gleason > 8) PCa. Hospitals were classified by average annual FV to determine if higher volume centers influenced choice of management for high and low risk patients. We performed logistic regression analysis which controlled for age, race, clinical stage, facility volume, facility type, insurance, Charlson comorbidity index, PSA, year of diagnosis, geographic location, and neighborhood income.

Results

For Group (1), the utilization of NDM (active surveillance or watchful waiting) continues to be underutilized and did not directly correlate with FV as shown in Figure 1a. The rate of NDM at the Top 5% FV was 16.9% versus 17.4% at Lowest Frequency FV. Significant predictors of NDM in low risk PCa were uninsured status OR 2.62 and unknown insurance status OR 1.76, as well as year of diagnosis (2013 OR 2.57 versus 2010). For Group (2), radical prostatectomy (RP) utilization correlated with higher FV centers; rates of RP at Top 5% FV were (49.7%) versus (13.9%) at the Lowest Frequency FV. EBRT utilization was inversely correlated with higher FV centers as shown in Figure 1b. HT was given in addition to EBRT on average (83.8%) of the time and was similar across all facilities (range 82.2%-85.3%).

Conclusions

FV did not correlate with choice of NDM in low risk patients. In high risk patients however, higher volume centers were more likely to choose RP and lower volume centers were more likely to utilize EBRT + HT.

Funding

none