Treatment rates for prostate cancer have declined significantly since the US Preventive Services Task Force first sounded the alarm about harms from routine use of prostate-specific antigen testing in 2008 (for older men) and again in 2012 (for all men), a new study concludes.
However, among men diagnosed with the disease, treatment rates have changed very little, the researchers report.
The study, which was published in the January issue of Health Affairs, is the first population-level analysis of curative prostate cancer treatment rates.
“Treatment rates were actually decreasing prior to the task force’s first recommendation in 2008, and that probably highlights the fact that physicians were already thinking about ways to minimize overdiagnosis and overtreatment,” lead author Tudor Borza, MD, research fellow, Institute for Healthcare Policy and Innovation, the University of Michigan Health System, Ann Arbor, told Medscape Medical News.
“So that in part is responsible for the 42% decline in the treatment rates we saw over the study interval,” he commented.
“But the largest drops in treatment rates occurred following recommendations made in 2008 and then again in 2011 to 2012, so this makes us think that screening recommendations certainly have had a significant overall impact on treatment for prostate cancer across the population as a whole,” he added.
National Sample of Men
Investigators carried out a retrospective study of a national sample of men covered by Medicare to assess whether treatment of newly diagnosed prostate cancer had changed between 2007 and 2012.
The sample was restricted to fee-for-service beneficiaries aged 66 years and older. Patients in Medicare managed care plants were excluded.
“We aimed to assess trends in both the population-based rate of treatment (which is sensitive to changes in both diagnosis and treatment patterns) and the rate of treatment among diagnosed men (which is sensitive to changes in treatment patterns only),” Dr Borza and colleagues write.
More than 67,000 patients with newly diagnosed prostate cancer were identified, almost three quarters of whom (72%) received curative treatment within a year of their being diagnosed.
Most men were younger than 75 years at the time of their diagnosis, although close to 16% were at least 80 years of age or older.
Approximately one third of men who underwent treatment received radiation therapy followed by surgery and brachytherapy, the researchers report.
In real numbers, curative treatment rates per 1000 men decreased from 4.3 in 2007 to 2.5 in 2012, the team reports, which is a 42% reduction in treatment rates for newly diagnosed prostate cancer during that period. The largest decreases in curative treatment rates at the population level were seen between 2007 to 2008, during which time the rates dropped 15%, and again between 2011 to 2012, during which time they declined by 21%.
“By comparison, over the same time period, the rate per 1000 diagnosed men decreased by only 8%, from 718 to 659,” researchers add. The largest decrease in treatment rates among men diagnosed with prostate cancer was 3.5%, which occurred between 2011 and 2012. Continue Reading