title: Treatment choice and quality of care for men with localized prostate cancer.
abstract: BACKGROUND
  Variations in patterns of care and treatment outcomes suggest differences in the quality of care for men treated for localized prostate cancer.
  
  
  OBJECTIVE
  We sought to compare adherence with quality indicators for prostate cancer care among men treated with radical prostatectomy or external beam radiation therapy.
  
  
  METHODS
  We sampled 5230 men diagnosed in 2000 or 2001 with early-stage prostate cancer from 984 facilities reporting to the National Cancer Data Base. Our analytic cohort includes 2604 men (from 770 facilities) treated with radical prostatectomy or external beam radiation.
  
  
  METHODS
  Subject-level compliance with the RAND quality indicators for localized prostate cancer care, stratified by treatment. We applied sampling weights to obtain national estimates of quality indicator adherence.
  
  
  RESULTS
  The weighted samples represent 24,547 and 27,125 men treated with radical prostatectomy or external beam radiation therapy, respectively. Compliance with several quality indicators approached 100% in both treatment groups; however treatment-specific variations were noted. Men receiving radiation were less likely than those undergoing surgery to be treated in facilities with a board-certified urologist (odds ratio [OR] = 0.4, 95% confidence interval [95% CI] = 0.2-0.8). Adherence with process of care indicators was appreciably higher among radiation subjects, including documentation of clinical stage (OR = 7.5, 95% CI = 4.8-11.9), pretherapy assessment of urinary (OR = 2.8, 95% CI = 1.9-4.2) and sexual (OR = 1.6, 95% CI = 1.2-2.2) function, and discussion of treatment options (OR = 1.8, 95% CI = 1.1-2.9).
  
  
  CONCLUSIONS
  Documented compliance with process of care quality indicators among men with localized prostate cancer appears superior for those treated with external beam radiation compared with those treated surgically.
authors: Department of Urology, University of Michigan, Ann Arbor, USA.
authors: David C
authors: DC
authors: Miller
authors: Benjamin A
authors: BA
authors: Spencer
authors: Jamie
authors: J
authors: Ritchey
authors: Andrew K
authors: AK
authors: Stewart
authors: Rodney L
authors: RL
authors: Dunn
authors: Howard M
authors: HM
authors: Sandler
authors: John T
authors: JT
authors: Wei
authors: Mark S
authors: MS
authors: Litwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D015331:Cohort Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy / Q000592:standards / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D019984:Quality Indicators, Health Care; D011878:Radiotherapy / Q000592:standards / Q000706:statistics & numerical data; D014481:United States