Matthew J Roberts1,2, Nathan Papa3,4,5, Marlon Perera1,2,5, Andre Joshi2, Susan Scott1, Damien Bolton5,6, Nathan Lawrentschuk5,6,7, John Yaxley1,8. 1. Faculty of Medicine, The University of Queensland, Brisbane, Australia. 2. Department of Urology, Princess Alexandra Hospital, Brisbane, Australia. 3. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia. 4. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. 5. University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia. 6. EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Australia. 7. Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia. 8. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Abstract
AIM: To describe national surgical patterns of prostate cancer (PCa) care considering radical prostatectomy with or without pelvic lymphadenectomy and consideration of robotic-assisted techniques. METHODS: Retrospective analysis of publicly accessible Medicare claims data was performed for the period 2001-2016 and included patients undergoing radical prostatectomy with or without pelvic lymphadenectomy relative to total and PCa-specific populations among men aged 45-84 years. Proportion of cases performed robotically was considered. RESULTS: Total procedures performed increased from 2001, peaked in 2009 and subsequently decreased until 2016. Since 2009, the age-specific rate of surgery in men aged 75-84 increased by 2.3-fold, whereas the rates for men aged 55-64 and 45-54 reduced by 44% and 55%, respectively. Rates of concurrent pelvic lymphadenectomy fell until 2009 with subsequent stabilization (ratio 1.05-1.14) through to 2016. Significant regional practice patterns were observed, as was an increasing trend toward a robotic-assisted laparoscopic approach, comprising more than 80% of radical prostatectomies in 2016. CONCLUSION: Since the peak in 2009, radical prostatectomy is performed less in men <65 years and more in men ≥65 years. An increasing proportion of cases omit concurrent pelvic lymphadenectomy and are performed robotically.
AIM: To describe national surgical patterns of prostate cancer (PCa) care considering radical prostatectomy with or without pelvic lymphadenectomy and consideration of robotic-assisted techniques. METHODS: Retrospective analysis of publicly accessible Medicare claims data was performed for the period 2001-2016 and included patients undergoing radical prostatectomy with or without pelvic lymphadenectomy relative to total and PCa-specific populations among men aged 45-84 years. Proportion of cases performed robotically was considered. RESULTS: Total procedures performed increased from 2001, peaked in 2009 and subsequently decreased until 2016. Since 2009, the age-specific rate of surgery in men aged 75-84 increased by 2.3-fold, whereas the rates for men aged 55-64 and 45-54 reduced by 44% and 55%, respectively. Rates of concurrent pelvic lymphadenectomy fell until 2009 with subsequent stabilization (ratio 1.05-1.14) through to 2016. Significant regional practice patterns were observed, as was an increasing trend toward a robotic-assisted laparoscopic approach, comprising more than 80% of radical prostatectomies in 2016. CONCLUSION: Since the peak in 2009, radical prostatectomy is performed less in men <65 years and more in men ≥65 years. An increasing proportion of cases omit concurrent pelvic lymphadenectomy and are performed robotically.
Authors: Andrew T Gabrielson; Marisa M Clifton; Christian P Pavlovich; Michael J Biles; Mitchell Huang; Jacqueline Agnew; Phillip M Pierorazio; Brian R Matlaga; Petar Bajic; Zeyad R Schwen Journal: Nat Rev Urol Date: 2021-01-11 Impact factor: 14.432