Pelvic lymphadenectomy and radical prostatectomy in the elderly: inverse trends observed in Australian population data

Abstract

Background: Increased utilization of active surveillance for indolent prostate cancer and radical prostatectomy (RP) with/without pelvic lymphadenectomy (PLND) for high risk, locally advanced disease are evolutions in surgical patterns of prostate cancer care.We sought to describe trends in surgical patterns of care for prostate cancer in Australia. Methods: Publicly accessible Medicare claims data using item numbers for RP and RP with PLND were accessed for the period 2005-2015 and described per 100,000 (105) men aged 45-84years. Overall, age-related and geographical trends were analysed considering prostate cancer incidence. Results: Total RPs performed peaked in 2009 (164.6/105 men) with a subsequent decrease until 2015 (131.9/105 men), driven by reduced RPs in younger men. Men aged 55-64 years (255.5/105 to 155.5/105) and 45-54 years (59.7/105 to 29.1/105) displayed the greatest reduction. RP among men aged 75-84 years increased after 2009 (34.4/105 to 77.1/105). Similar trends were observed individually for RP and RP with PLND.RP alone wasmore common in men <65 years and RP with PLND more common inmen aged ≥ 65. When a PLND:noPLND ratio was calculated, PLND use reduced from 2005-2015 (overall 1.8 to 1.06). Greatest reductions in the use of PLND were observed for NSW (3.9 to 2.1) and QLD (1.6 to 0.5), while an increase was observed in SA (0.6 to 1.2). Conclusions: Currently, RP is performed less in younger men and more in older men. PLND at the time of RP is performed less commonly nationwide, except in South Australia. Medicare claims registry data describes evolution in surgical patterns of care for prostate cancer in Australia.L617436410 <br />