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Patterns of Care and Outcomes for Prostate Cancer in the United States

Principal Investigator
Name
Paul Nguyen
Degrees
MD
Institution
Brigham and Women's Hospital
Position Title
Associate Professor of Radiation Oncology
Email
About this CDAS Project
Study
PLCO (Learn more about this study)
Project ID
PLCO-149
Initial CDAS Request Approval
Aug 17, 2015
Title
Patterns of Care and Outcomes for Prostate Cancer in the United States
Summary
Prostate cancer is the most common non-skin malignancy affecting American men, with a substantial impact on patient quality of life, patient survival, and national health care expenditures. The role of screening for prostate cancer in various sub-populations of men is controversial, even after the PLCO trial results were published in 2009. In addition, the treatment of prostate cancer remains controversial, including whether low-risk disease requires treatment at all, the optimal local therapy for intermediate-risk and high-risk disease, and the optimal nature and duration of systemic therapy for intermediate-risk and high-risk disease. In addition, the ideal risk stratification for prostate cancer remains unknown. Finally, recent work has highlighted heterogeneity in the type of care received and outcomes based on race, age, and other demographic/socioeconomic factors.

While these issues are central to the appropriate management of men with prostate cancer or who are interested in prostate cancer screening, it is difficult to study some of these questions using single-institution databases due to inadequate statistical power. In order to make meaningful conclusions about patterns of care in the US and outcomes related to prostate cancer, we wish to study the PLCO dataset, which is a large database with 77,000 patients, and which contains some patient-specific data that is not found in other large cancer databases.

In addition to general issues regarding patterns of care in prostate cancer and outcomes, our research group is focused on the use of androgen deprivation therapy (ADT) for prostate cancer. In particular, we are interested in patterns in the use of ADT as well as the effectiveness and toxicities of ADT for different risk groups of men with prostate cancer. Our group is also interested in socioeconomic and demographic disparities in the treatment and outcomes of prostate cancer.
Aims

1. We wish to characterize the usage of ADT in relation to prostate cancer screening. In particular, we wish to understand whether prostate cancer diagnosis due to screening is associated with a reduced rate of ADT receipt compared to prostate cancer diagnosis diagnosed without screening (controlling for clinical risk factors). The PLCO database is uniquely able to answer this question as this will be a comparison between two arms of the randomized trial.
2. We wish to characterize the utilization of androgen deprivation therapy (ADT), toxicity (e.g. cardiovascular death) from ADT, and predictors of toxicity (e.g. cardiovascular comorbidity). This work may help target underserved subgroups of patients and perhaps identify subsets of patients who might be able to benefit the most or experience the least toxicity from ADT.
3. We wish to characterize risk factors for noncompliance with screening or non-screening of the trial. In particular, we hope to determine which factors predict not receiving screening after randomization to the screening arm of the trial and which factors predict receiving screening after randomization to the control arm of the trial. Identification of such factors may help clinicians target patients that might be the most likely to be noncompliant with screening recommendations.
4. We wish to determine whether screening affects the kind of treatment received for men diagnosed with prostate cancer, stratified by risk group, and whether screening might reduce treatment and outcome disparities among the various risk groups.
5. We wish to characterize the general patterns of prostate cancer care and outcomes in men, including screening practices, receipt of treatment, and survival analysis. We will also study how patient demographic/socioeconomic factors and clinical characteristics impact these patterns of care and outcomes.
6. We wish to characterize the incidence of prostate cancer, stratified by clinical characteristics (e.g. NCCN risk group, grade, stage, family history, social history), patient demographic factors (e.g. race, age), and participation in screening.
7. Does the impact of screening on prostate cancer mortality differ by subgroups defined by race, comorbidity, and baseline clinical and sociodemographic factors?

Collaborators

None.

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