In:
Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 10, No. 11-12 ( 2016-12-15), p. 410-
Abstract:
Introduction: We aimed to determine the impact of clinical practice guidelines (CPG) on rates of radiation oncologist (RO) referral, androgen-deprivation therapy (ADT), radiation therapy (RT), and radical prostatectomy (RP) in patients with high-risk prostate cancer (HR-PCa).Methods: All men 〉 18 years, diagnosed with PCa in 2005 and 2012 were identified from the Alberta Cancer Registry. Patient age, aggregated clinical risk group (ACRG) score, Gleason score (GS), pre-treatment prostate-specific antigen (PSA), RO referral, and treatment received were extracted from electronic medical records. Logistic regression modelling was used to examine associations between RO referral rates and relevant factors.Results: HR-PCa was diagnosed in 261 of 1792 patients in 2005 and 435 of 2148 in 2012. Median age and ACRG scores were similar in both years (p 〉 0.05). The rate of patients with PSA 〉 20 were 67% and 57% in 2005 and 2012, respectively (p=0.004). GS ≤6 was found in 13% vs. 5% of patients, GS 7 in 27% vs. 24%, and GS ≥8 in 59% vs. 71% in 2005 and 2012, respectively (p 〈 0.001). In 2005, RO referral rate was 68% compared to 56% in 2012 (p=0.001), use of RT + ADT was 53% compared to 32% (p 〈 0.001), and RP rate was 9% vs. 17% (p=0.002). On regression analysis, older age, 2012 year of diagnosis and higher PSA were associated with decreased RO referral rates (odds ratios [OR] 0.49, 95% confidence interval [CI] 0.39–0.61; OR 0.51, 95% CI 0.34–0.76; and OR 0.64, 95% CI 0.39–0.61), respectively [p 〈 0.001]).Conclusions: Since CPG creation in 2005, RO referral rates and ADT + RT use declined and RP rates increased, which demonstrates a need to improve adherence to CPG in the HR-PCa population.
Type of Medium:
Online Resource
ISSN:
1920-1214
,
1911-6470
Language:
Unknown
Publisher:
Canadian Urological Association Journal
Publication Date:
2016
detail.hit.zdb_id:
2431403-1
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