Secondary Therapy in Localized Prostate Cancer: How Often Is It Employed and What Predicts Its Use?
Objectives:
- To assess the rate of utilization of secondary therapies five years following
diagnosis of prostate cancer in the PCOS cohort.
- To identify independent clinical and sociodemographic risk factors for secondary
therapy using appropriate multivariate methodology.
- To compare patient report of receipt of secondary therapy five years following
diagnosis to medical record abstraction.
Rationale:
Despite earlier detection of prostate cancer and technical improvements in both surgery
and radiotherapy, at least 25% of patients will experience a recurrence of their disease
sometime after aggressive treatment. Despite the fact that the use of these secondary
therapies is common clinical practice, little is known regarding how often they are
actually employed and if there are easily identifiable clinical and/or sociodemographic
risk factors that might identify patients who are at high-risk for secondary treatment.
Results of this study will improve our understanding how often these therapies are
employed and what influences their utilization. This knowledge will assist in giving men
a better understanding of what they can anticipate following a diagnosis and treatment of
prostate cancer and may identify previously unrecognized disparities in care. Finally,
the information from this study will be useful in future analyses of the effectiveness of
secondary therapies in preventing prostate cancer mortality, as it may identify potential
confounders.
Data:
The 5-year patient survey data and medical record abstraction will be the most recently
collected information to be used for this analysis. We will also incorporate data from the
prior PCOS surveys and medical records abstracts.
Methods:
The primary outcome of interest, secondary therapy will be assessed using both patient
self-report and medical record review. Using receipt of secondary therapy of any type by
5 years as the dependent variable, multivariable logistic regression models will be
developed that will include the following independent variables: study center, age at
diagnosis, stage at diagnosis, grade at diagnosis, PSA at baseline (if available), primary
treatment received, income, education, marital status, race, co-morbidity and baseline
functional status (urinary, sexual and bowel function). Additional multivariate models
will be developed stratified by treatment (surgery, radiotherapy, hormonal therapy and
watchful waiting). Depending upon the rates of use of specific secondary therapies,
additional logistic regression models using receipt of a particular secondary therapy by
five years may also be developed. All analyses that implemented the sample weight
adjustment will be performed with SUDAAN at the two-sided significance level of 0.05
(α=0.05).
Dissemination:
Peer-reviewed Scientific Journal
Target Schedules:
Analysis to begin: October 2004
First draft completed: February 2005
Paper submitted: May 2005
Collaborators:
David F. Penson, Ann Hamilton, Janet Stanford, Todd Alonzo and others.
Contact information:
David F. Penson, MD, MPH
Associate Professor of Urology and Preventive Medicine
Keck/USC School of Medicine
1441 Eastlake Avenue, Suite 7416
Los Angeles, CA 90089
Phone: (323) 865-3716
Fax: (323) 865-0120
E-mail: penson@usc.edu
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