title: Low rates of adjuvant radiation in patients with nonmetastatic prostate cancer with high-risk pathologic features.
abstract: BACKGROUND
  The 2013 American Urological Association/American Society for Radiation Oncology consensus guidelines recommend offering adjuvant radiotherapy (RT) after radical prostatectomy in patients with high-risk pathologic features for recurrence. In the current study, the authors examined practice patterns of adjuvant RT use in patients with elevated pathologic risk factors over a time period spanning the publication of supporting randomized evidence.
  
  
  METHODS
  Using the National Cancer Data Base, a total of 130,681 patients were identified who underwent surgical resection for prostate cancer between 2004 and 2011 with at least 1 of the following pathologic risk factors for early biochemical failure: pT3a disease or higher, positive surgical margins and/or lymph node-positive disease. Using multivariable logistic regression, the authors examined factors associated with adjuvant RT use including patient, clinical, demographic, and temporal characteristics.
  
  
  RESULTS
  Adjuvant RT was administered to 9.9% of the patients with at least 1 pathologic risk factor. Use of adjuvant RT did not change over the study period (P  = .23). On multivariable analysis, we found that patients treated at high-volume surgical facilities were less likely to receive adjuvant RT (15.9% vs 7.8%; odds ratio, 0.58 [95% confidence interval, 0.50-0.65]; P < .0001). Older age, comorbidities, black race, lower income, and lower population density were also associated with lower rates of adjuvant RT.
  
  
  CONCLUSIONS
  Use of adjuvant RT is uncommon and remained unchanged between 2004 and 2011. Patients treated at high-volume surgical facilities are less likely to receive adjuvant RT, irrespective of margin status.
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Anusha
authors.initials: A
authors.lastname: Kalbasi
authors.forename: Samuel
authors.initials: S
authors.lastname: Swisher-McClure
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Robert
authors.initials: R
authors.lastname: Sunderland
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: adjuvant; patterns of care; prostate cancer; radiation; surgical volume