Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany: a comparative population-based study.
Current guidelines do not recommend a preferred treatment modality for locally advanced prostate cancer. The aim of the study was to compare treatment patterns found in the USA and Germany and to analyze possible trends over time.



We compared 'Surveillance Epidemiology and End Results' (SEER) data (USA) with reports from four German federal epidemiological cancer registries (Eastern Germany, Bavaria, Rhineland-Palatinate, Schleswig-Holstein), both from 2004 to 2012. We defined locally advanced prostate cancer as clinical stage T3 or T4. Exclusion criteria were metastatic disease and age over 79 years.



We identified 9127 (USA) and 11 051 (Germany) patients with locally advanced prostate cancer. The share was 2.1% in the USA compared with 6.0% in Germany (P<0.001). In the United States, the utilization of radiotherapy (RT) and radical prostatectomy (RP) was comparably high with 42.0% (RT) and 42.8% (RP). In Germany, the major treatment option was RP with 36.7% followed by RT with 22.1%. During the study period, the use of RP increased in both countries (USA P=0.001 and Germany P=0.003), whereas RT numbers declined (USA P=0.003 and Germany P=0.002). The share of adjuvant RT (aRT) was similar in both countries (USA 21.7% vs Germany 20.7%).



We found distinctive differences in treating locally advanced prostate cancer between USA and Germany, but similar trends over time. In the last decade, a growing number of patients underwent RP as a possible first step within a multimodal concept.
Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
B
B
Hager
National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany.
K
K
Kraywinkel
Department of Urology, University Hospital Erlangen, Erlangen, Germany.
B
B
Keck
Institute of Clinical Epidemiology, University Hospital Schleswig-Holstein, Lübeck, Germany.
A
A
Katalinic
Population-Based Cancer Registry, Bavaria, Nuremberg, Germany.
M
M
Meyer
Cancer Registry Rhineland-Palatinate, Mainz, Germany.
S R
SR
Zeissig
Common Cancer Registry of The Federal States Berlin/Brandenburg/Mecklenburg-Vorpommern/Sachsen-Anhalt/Sachsen/Thüringen, Berlin, Germany.
R
R
Scheufele
Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
M P
MP
Wirth
Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
J
0000-0001-7243-8958
J
Huber
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy / Q000379:methods / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D012042:Registries; D018426:SEER Program; D014481:United States / Q000453:epidemiology