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

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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.

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Funding

Michael S. Leapman: NIH/NCI K08CA237872.

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Authors and Affiliations

  1. Department of Urology, Yale School of Medicine, 789 Howard Avenue, FMP 300, New Haven, CT, 06520, USA

    Kamyar Ghabili, Preston C. Sprenkle, Kevin A. Nguyen & Michael S. Leapman

  2. Department of Surgery, Yale School of Medicine, New Haven, CT, USA

    Kamyar Ghabili

  3. Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA

    Henry S. Park & James B. Yu

  4. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA

    Henry S. Park, James B. Yu, Xiaomei Ma, Cary P. Gross & Michael S. Leapman

  5. Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

    Simon P. Kim

  6. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Xiaomei Ma

  7. Department of Medicine, Yale School of Medicine, New Haven, CT, USA

    Cary P. Gross

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  1. Kamyar Ghabili
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Contributions

KG: project development, data management and analysis, and manuscript writing; HSP: data analysis and manuscript writing; JBY: data analysis and manuscript writing; PCS: manuscript writing; SPK: data analysis and manuscript writing; KAN: data management and analysis, and manuscript writing; XM: data analysis and manuscript writing; CPG: data analysis and manuscript writing; MSL: project development, data management and analysis, and manuscript writing.

Corresponding author

Correspondence to Michael S. Leapman.

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Conflict of interest

Dr. Park has received honoraria from Varian Medical Systems, Inc., and Rad Onc Queestions, LLC. Dr. Yu has received research funding from 21st Century Oncology, and consulting fees from Augmenix Inc. Dr. Sprenkle serves as a consultant for Boston Scientific and GenomeDx Biosciences. Dr. Ma has received research funding from Celgene Corp. Dr. Gross has received research funding from NCCN/Pfizer, and travel funding from Flatiron, and funding from Johnson & Johnson to help design new approaches for sharing clinical trial data. Dr. Leaspman has received research funding from BESO Biologic. Dr. Ghabili, Mr. Nguyen, and Dr. Kim declare no potential conflict of interest.

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345_2020_3298_MOESM1_ESM.jpg

Supplementary Figue S1. Bar graph depicting time to radiation therapy among patients ultimately receiving planned RT. (JPG 48 kb)

345_2020_3298_MOESM2_ESM.jpg

Supplementary Figure S2. Distribution of postoperative management strategies by diagnosis year and type of planned RT. (JPG 52 kb)

Supplementary Table 1 (DOCX 18 kb)

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Ghabili, K., Park, H.S., Yu, J.B. et al. National trends in the management of patients with positive surgical margins at radical prostatectomy. World J Urol 39, 1141–1151 (2021). https://doi.org/10.1007/s00345-020-03298-6

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  • DOI: https://doi.org/10.1007/s00345-020-03298-6

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