title: Significant increase in prostatectomy and decrease in radiation for clinical T3 prostate cancer from 1998 to 2012.
abstract: OBJECTIVE
  We aimed to describe changes in treatment patterns for clinical T3 prostate cancer (PCa) from 1998 to 2012, specifically investigating what factors influence receipt of prostatectomy or radiation.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results database, we studied 11,604 men with clinical T3N0M0 PCa from 1998 to 2012, with treatment categorized as radiation, radical prostatectomy (RP), or no curative therapy. We calculated rate of treatment type by year of diagnosis to investigate trends in treatment patterns, further stratifying by clinical T3a, defined as unilateral and bilateral extracapsular extension (n = 3,842), vs. T3b (defined as extension to seminal vesicles (n = 3,665). Finally, a multivariable logistic regression analysis measured association of demographic and clinical variables with type of treatment received for years 2010 to 2011.
  
  
  RESULTS
  Rates of prostatectomy increased significantly from 1998 to 2012 (12.5% vs. 44.4%), radiation decreased significantly (55.8% vs. 38.4%), and receipt of no treatment also decreased (31.7% vs. 17.2%, all P<0.001). These trends were similar for clinical T3a and T3b. Rates of prostatectomy surpassed radiation by 2008 in clinical T3a, reaching 49.8% vs. 37.1%, respectively, in 2012 (P = 0.002), and were statistically similar to radiation in 2012 for clinical T3b, reaching 41.6% vs. 42.1% (P = 0.92). Multivariable logistic regression analysis demonstrated that patients were less likely to receive prostatectomy than radiation if biopsy Gleason scores of 8 to 10 (adjusted odds ratio [AOR] = 0.41, 0.32-0.53), higher initial prostate-specific antigen (AOR = 0.97, 0.97-0.98), and older age (AOR = 0.92, 0.90-0.03, all P<0.01). The likelihood of RP was similar among cT3b vs. cT3a (AOR = 0.95, 0.71-1.26, P = 0.74).
  
  
  CONCLUSIONS
  Since 1998, there has been a significant increase in the use of RP for clinical T3 PCa and a significant decrease in the use of radiation such that in 2012, the use of prostatectomy exceeded the use of radiation.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Nezolosky
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Kathryn T
authors.initials: KT
authors.lastname: Dinh
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Muralidhar
authors.affiliation: Department of Internal Medicine, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.affiliation: Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: pnguyen@LROC.harvard.edu.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*
keywords: Clinical T3 disease; Prostate cancer; Prostatectomy; Radiation therapy; Treatment patterns