National trends in the management of patients with positive surgical margins at radical prostatectomy.

Ghabili K, Park HS, Yu JB, Sprenkle PC, Kim SP, Nguyen KA, Ma X, Gross CP, Leapman MS. National trends in the management of patients with positive surgical margins at radical prostatectomy. World journal of urology. 2021 Apr 1; 39(4):1141-1151.

Related HSR&D Project(s)

• IIR 15-356 – A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging

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Abstract:

PURPOSE: To evaluate practice patterns of planned post-operative radiation therapy (RT) among men with positive surgical margins (PSM) at radical prostatectomy. METHODS: We identified 43,806 men within the National Cancer Database with pathologic node-negative prostate cancer diagnosed in 2010 through 2014 with PSM. The primary endpoint was receipt of planned (RT) within a patient's initial course of treatment. We examined post-RP androgen deprivation therapy (ADT) with RT as a secondary endpoint. We evaluated patterns of post-operative management and characteristics associated with planned post-prostatectomy RT. RESULTS: Within 12 months of RP, 87.0% received no planned RT, 8.5% RT alone, 1.3% ADT alone, and 3.1% RT with ADT. In a multivariable logistic regression model, planned RT use was associated with clinical and pathologic characteristics as estimated by surgical Cancer of the Prostate Risk Assessment (CAPRA-S) category (intermediate versus low, OR? = 2.87, 95% CI 2.19-3.75, P? < 0.001; high versus low, OR? = 10.23, 95% CI 7.79-13.43, P? < 0.001), treatment at community versus academic centers (OR? = 1.24, 95% CI 1.15-1.34, P? < 0.001), shorter distance to a treatment facility (OR? = 0.97 for each 10-mile, 95% CI 0.96-0.98, P? < 0.001), and uninsured status (OR? = 1.39, 95% CI 1.10-1.77, P? = 0.005). The odds of receiving planned RT were lower in 2014 versus 2010 (OR? = 0.76, 95% CI 0.68-0.85, P? < 0.001). There was no significant change in the use of ADT with RT. High versus low CAPRA-S category was associated with the use of ADT in addition to RT (OR? = 5.13, 95% CI 1.57-16.80, P? = 0.007). CONCLUSION: The use of planned post-prostatectomy RT remained stable among patients with PSM and appears driven primarily by the presence of other adverse pathologic features.