title: Australian patterns of prostate cancer care: Are they evolving?
abstract: BACKGROUND
  Approaches to prostate cancer (PCa) care have changed in recent years out of concern for overdiagnosis and overtreatment. Despite these changes, many patients continue to undergo some form of curative treatment and with a growing perception among multidisciplinary clinicians that more aggressive treatments are being favored. This study examines patterns of PCa care in Australia, focusing on current rates of screening and aggressive interventions that consist of high-dose-rate (HDR) brachytherapy and pelvic lymph node dissection (PLND).
  
  
  METHODS
  Health services data were used to assess Australian men undergoing PCa screening and treatment from 2001 to 2014. Age-specific rates of prostate-specific antigen (PSA) screening were calculated. Ratios of radical prostatectomy (RP) with PLND to RP without PLND, and HDR brachytherapy to low-dose-rate (LDR) brachytherapy were determined by state jurisdictions.
  
  
  RESULTS
  From 2008, the rate of PSA screening trended downward significantly with year for all age ranges (P < 0.02) except men aged ≥ 85 (P = 0.56). PLND rates for 2008-2014 were lower than rates for 2001-2007 across all states and territories. From 2008 to 2014, PLND was performed ≥ 2.7 times more frequently in New South Wales and the Australian Capital Territory than in other jurisdictions. Since 2007, brachytherapy practice across Australia has evolved towards a relatively low use of HDR brachytherapy (ratio of HDR to LDR brachytherapy < 0.5 for all jurisdictions except the Australian Capital Territory).
  
  
  CONCLUSIONS
  Rates of PLND and HDR brachytherapy for PCa have declined in Australia, providing evidence for the effect of stage migration due to widespread PSA screening. Currently, PSA screening rates remain high among older men, which may expose them to unnecessary investigations and treatment-related morbidity.
authors.affiliation: University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Lo
authors.affiliation: University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Papa
authors.affiliation: University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia.
authors.forename: Damien M
authors.initials: DM
authors.lastname: Bolton
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
authors.affiliation: University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
keywords: Brachytherapy; Lymph node excision; Mass screening; Prostatectomy; Prostatic neoplasms