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Show Aggressive Treatment Patterns in Prostate Cancer Cases in Utah and the United States Ray M. Merrill, Ph.D., M.P.H. Abstract Despite continued debate over the efficacy of aggressive prostate cancer treatment, the majority of prostate cancer cases undergo such treatment. The percentage of early staged prostate cancer among white men undergoing radical prostatectomy or radiation is compared between data from the Utah Cancer Registry and the ten other cancer registries belonging to the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute by calendar year and age. Analysis is based on the years 1992 through 1996. Prostate cancer cases in Utah are more likely to undergo radical prostatectomy and less likely to receive radiation therapy than cases in SEER (excluding Utah). Higher radical prostatectomy use and lower radiation use among cases in Utah tends to occur across age groups and specific SEER registries. In addition, use of radical prostatectomy exceeds that of radiation therapy through older ages in Utah than in SEER (excluding Utah). There continues to be considerable debate over the efficacy of aggressive treatment for prostate cancer. Resolving this debate is difficult because of the biologic unpredictability of many prostate tumors and because of insufficient evidence from randomized clinical trials on the efficacy of select treatment modalities. Nevertheless, the majority of men diagnosed with prostate cancer undergo either a radical prostatectomy or radiation therapy (Harlan et al., 2001; Stanford et al., 1999). In this paper, we present patterns of aggressive treatment for early staged prostate cancer in Utah and compare these patterns with those in the United States. Methods Analyses are based on public-use data from the eleven cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute for the years 1992-1998 (Hankey, Ries, & Edwards, 1999). These registries include San Francisco-Oakland, Connecticut, Detroit (metropolitan), Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah, Atlanta (metropolitan), San Jose - Monterey, and Los Angeles and represent approximately 14% of the U.S. population. Utah and the other cancer registries follow standards instituted by the SEER Program and the North American Association of Central Cancer Registries (Ries & Fritz, 1998, North American Association of Central Cancer Registries, 2000). Cancer registry staff members and local cancer registrars obtain demographic, tumor, and treatment information on cases from specific statements in hospital medical records, clinical and nursing home records, and records from private pathology laboratories and radiotherapy units. We identified 6,595 cases in Utah and 108,417 cases among whites in SEER (excluding Utah) with histologically confirmed local/regional-staged prostate cancer, based on the International Classification of Diseases for Oncology (ICD-O-2) code C619. The study was restricted to local- (confined to the prostate gland) and regional- (spread to contiguous organs or lymph nodes) staged cases because of our interest in assessing treatments with intent to cure. Although candidates for radical prostatectomy should have their tumors confined to the prostate gland and have a negative bone scan, considerable upstaging to regional stage may occur at the time of surgery. In particular, the SEER Program reports only the final pathological stage, which is determined using all of the surgical information obtained. Several patient level studies (Bostwick, 1997; Cata-lona & Bigg, 1990; Ennis, Flynn, Fischer, & Peschel, 1994; Montironi, 1999) and a recent population-based study (Merrill, 2001) have identified a large Utah's Health: An Annual Review Volume VIII 23 |