High Provider Volume Is Associated With Lower Rate Of Secondary Therapies After Definitive Radiotherapy For Localized Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Radiology / Nuclear Medicine
Article Date: 20 Jan 2008 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

UroToday.com- High provider volume has been correlated with improved outcomes for a variety of therapies, including surgical management of genitourinary malignancies. In the online version of European Urology, Dr. Jeldres and investigators report on the outcomes of 3,907 patients treated with radiotherapy (XRT) for prostate cancer (CaP) and stratified by provider volume.

Patients studied were treated between 1989 and 2000 in Canada by a total of 72 radiation oncologists. Those receiving androgen deprivation therapy (ADT) prior to or within one year of XRT were not included in the study. The cumulative provider volume ranged form 1 to 347 cases. The average annual volume ranged form 1 to 39 cases with a median of 10 cases. Median followup was 6.2 years. Secondary therapy was ADT in 586 (15%), bilateral orchiectomy alone in 42 (1.1%), and both in 103 (2.6%). The estimated survival probabilities at 5 and 10 years after XRT were 79.5% and 61.3%, respectively.

Using an annual treatment volume of >10, the 10-year event-free survival was 63.8% compared to 58.6% for <10 treated patients per year. A decrease in the rate of secondary therapy delivery was seen in patients treated by radiation oncologists with an average annual provider volume in excess of 13 cases. Cumulative provider volume achieved independent predictor status in multivariable analysis and a decrease in the rate of secondary therapy delivery was seen in patients treated by radiation oncologists with a cumulative provider volume in excess of 200 cases. Patients with a higher number of comorbidities were less likely to receive secondary therapy.

Jeldres C, Suardi N, Saad F, Montorsi F, Shariat SF, Perrotte P, Bhojani N, Walz J, Hutterer GC, Graefen M, Valiquette L, Karakiewicz PI

Eur Urol. ePub: November 7, 2007
doi:10.1016/j.eururo.2007.10.070

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

----------------------------
Copyright © 2007 - UroToday
Reproduced for Medical News Today with permission of UroToday.
----------------------------