Age Migration and decreased use of pelvic lymphadenectomy more than radical prostatectomy over 15 years

Abstract

Introduction and objectives: Prostate cancer (CaP) is the most commonly diagnosed malignancy amongst Australian men, and in recent times the surgical trends of prostate cancer (PCa) care have changed. The reasons for this include increased utilization of active surveillance for indolent, low risk PCa and more radical prostatectomies (RP) being done with or without pelvic lymphadenectomy (PLND) for high risk, locally advanced disease. The aim of this study was to describe the Australian surgical patterns of PCa care considering utilisation of RP with or without PLND in Australian men over a significant period of time. Methods: For the period between 2001 and 2016, publically accessible Medicare claims data using item numbers for RP (37210) and RP with PLND (37211) were accessed and described per 100,000 (105) men aged 45-84 year. Data were stratified as raw totals for each year per age group (45-54, 55-64, 65-74, 75-84) and Australian state or territory (New South Wales; Victoria; QLD; WA; SA; TAS; ACT; NNT), collated in Excel and described per 100,000 (105) men aged 45-84 years for each state or territory. Based on this data, overall trends as well as agerelated and geographical trends were evaluated. Results: Total RPs performed increased from 2001 until peaking in 2009 with a subsequent decrease to 2016, driven by reduced RPs in men <65 years. As such from 2009 to 2016, the rates of RPs for men aged 55-64 and 45-54 reduced by 44% and 55% respectively. However, the rate of RPs in men aged 75-84 increased by 2-3 fold. The fraction of yearly PC incidence treated by RP in the private sector has been stable from 2009 to 2013 at around 30%, except for men aged 75 to 84 where the fraction increased from 3.4% to 6.5%. Rates in men aged 65-74 years were similar between 2009 and 2016 (<10% change). The rate of PLND at time of RP relative to RP without PLND fell until 2009 with subsequent stabilisation (ratio 1.05-1.14) through to 2016. Most Australian states more commonly perform RP without PLND, except in New South Wales where it is still performed at twice the rate. It was also found that New South Wales consistently performed most RPs per 100,000 men across the study period. Conclusion: In this retrospective analysis of Australian health systems data, since 2009, RP was shown to be performed less per 105 men <65 years and more in men =65 years. PLND at the time of RP is performed less commonly nationwide, except in New South Wales. In the absence of mature national PCa registry data, medicare claims registry data describes evolution in Australian surgical patterns of private practice PCa care.L6213521222018-03-27 <br />