Abstract
Purpose
To describe the national-level patterns of care for local ablative therapy among men with PCa and identify patient- and hospital-level factors associated with the receipt of these techniques.
Methods
We retrospectively interrogated the National Cancer Database (NCDB) for men with clinically localized PCa between 2010 and 2017. The main outcome was receipt of local tumor ablation with either cryo- or laser-ablation, and “other method of local tumor destruction including high-intensity focused ultrasound (HIFU)”. Patient level, hospital level, and demographic variables were collected. Mixed effect logistic regression models were fitted to identify separately patient- and hospital-level predictors of receipt of local ablative therapy.
Results
Overall, 11,278 patients received ablative therapy, of whom 78.8% had cryotherapy, 15.6% had laser, and 5.7% had another method including HIFU. At the patient level, men with intermediate-risk PCa were more likely to be treated with local ablative therapy (OR 1.05; 95% CI 1.00–1.11; p = 0.05), as were men with Charlson Comorbidity Index > 1 (OR 1.36; 95% CI 1.29–1.43; p < 0.01), men between 71 and 80 years (OR 3.70; 95% CI 3.43–3.99; p < 0.01), men with Medicare insurance (OR 1.38; 95% 1.31–1.46; p < 0.01), and an income < $47,999 (OR 1.16; 95% CI 1.06–1.21; p < 0.01). At the hospital-level, local ablative therapy was less likely to be performed in academic/research facilities (OR 0.45; 95% CI 0.32–0.64; p < 0.01).
Conclusions
Local ablative therapy for PCa treatment is more commonly offered among older and comorbid patients. Future studies should investigate the uptake of these technologies in non-hospital-based settings and in light of recent changes in insurance coverage.
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Data availability
Application and access to the registry can be obtained only if the provider or researcher is affiliated to a Commission on Cancer accredited program.
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MK: project development, data management, data analysis, manuscript writing. ML: data analysis and manuscript writing. NF: data management and manuscript editing. CPM: project development and manuscript editing. GS: project development and manuscript editing. SRL: project development, data analysis and manuscript editing. JW: project development and manuscript editing. CMM: project development, data management, and manuscript writing. CMT: project development and manuscript editing. KT: project development and manuscript editing. AG: project development and manuscript editing. ASK: project development and manuscript writing. Q-DT: project development, data analysis, and manuscript writing. APC: project development, data management, data analysis, manuscript writing.
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MK is supported by a postdoc fellowship from the German Academic Exchange Service (DAAD). CMT reports funding from NIH, Clinical trial support from InSightec Inc and serves as an advisor to Profound Medical ASK reports advisory board positions on hormone treatment for prostate cancer with Janssen and Myovant, and advisory board positions in the realm of prostate cancer with Bayer, Profound, Insightec, and Exelixis. ASK is also part of the Data Safety and Monitoring Committee with Bristol Myers Squibb and Advantage. QDT reports research funding from the American Cancer Society and Pfizer Global Medical Grants. APC reports research funding from the American Cancer Society and Pfizer Global Medical Grants. The remaining authors report no disclosures.
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An institutional review board waiver was obtained at Mass General Brigham (2016P000517).
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was granted by the Mass General Brigham Institutional Review Board (2016P000517).
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This is a de-identified data registry available to participating Commission of Cancer Institutions, and informed consent is not required.
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Koelker, M., Labban, M., Frego, N. et al. Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers: results from a national registry. World J Urol 41, 1309–1315 (2023). https://doi.org/10.1007/s00345-023-04354-7
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DOI: https://doi.org/10.1007/s00345-023-04354-7