A population-based analysis of contemporary patterns of care in younger men (<60 years old) with localized prostate cancer.
OBJECTIVE
To analyze patterns of care in younger patients (<60 years old) with localized prostate cancer and to identify factors associated with selection of therapy using a large, population-based database.


METHODS
The Surveillance, Epidemiology, and End Results database was queried to identify men <60 years old diagnosed with localized prostate cancer between 2010 and 2011. Patients were determined to have undergone no active treatment, local therapy, radiation therapy (RT), or radical prostatectomy (RP). Univariate and multivariate logistic regression analyses were performed to identify factors associated with the use of definitive therapy.


RESULTS
A total of 12,732 men were included in this analysis. For the entire cohort, 12.5 % received no definitive treatment, 61.6 % RP, 22.0 % RT, and 3.3 % RP with adjuvant RT. Among men with low-, intermediate-, and high-risk prostate cancer, 17.2, 7.1, and 15.9 %, respectively, received no definitive therapy. RP was the most common choice of definitive therapy, utilized in 74.6 % of patients. Adjuvant RT after RP was utilized in 16.2 % of cases with positive margin and/or pT3/pT4 disease. African-American race, single marital status, and Medicaid/no insurance were associated with a decreased likelihood of receiving definitive treatment.


CONCLUSIONS
A significant proportion of younger men diagnosed with localized prostate cancer, particularly with low- or high-risk disease, are not receiving definitive therapy. African-American men, uninsured men, and patients with Medicaid or no medical insurance are less likely to receive definitive treatment.
Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. andrew.wong@downstate.edu.|Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA. andrew.wong@downstate.edu.
Andrew T
AT
Wong
Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.|Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA.
Joseph J
JJ
Safdieh
UF Health Cancer Center - Orlando Health, Orlando, FL, USA.
Justin
J
Rineer
Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.|Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA.
Joseph
J
Weiner
Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.|Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA.
David
D
Schwartz
Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.|Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1211, Brooklyn, NY, 11203, USA.
David
D
Schreiber
D000230:Adenocarcinoma / Q000097:blood / Q000556:secondary / Q000628:therapy*; D001741:Black or African American / Q000706:statistics & numerical data; D001918:Brachytherapy / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017533:Marital Status; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States; D044465:White People / Q000706:statistics & numerical data
D017430:Prostate-Specific Antigen
Active surveillance; Patterns of care; Prostate cancer; Radiation; Radical prostatectomy; Young patients