Patterns of Care of Node-Positive Prostate Cancer Patients Across the United States: A National Cancer Data Base Analysis

Guideline recommendations for treatment vary widely for node-positive prostate cancer. Across the United States, 46.0% and 31.4% of patients received androgen deprivation therapy alone and radiotherapy, respectively, for clinical node-positive disease. For patients with pathologic node-positive disease, 60.3% and 17.0% received no adjuvant therapy and radiotherapy, respectively. Randomized trials are needed to define optimal care for node-positive prostate cancer patients. Background: Twelve percent of newly diagnosed prostate cancers in the United States are node-positive. In a setting of disparate treatment guideline recommendations for node-positive disease, this study describes the treatment patterns for clinical node-positive (cN⁺) and pathologic node-positive (pN⁺) patients across the United States. Materials and Methods: Using the National Cancer Data Base, men diagnosed with cN⁺ or pN⁺ disease were identified from 2006 to 2011. For each cohort, the proportion of patients who received radiotherapy (RT), androgen deprivation therapy (ADT), and other treatments was analyzed. Multivariable logistic regression models were used to examine patient and clinical factors associated with use of definitive treatment (RT or prostatectomy) in cN⁺ patients, and postprostatectomy RT in pN⁺ patients. Results: A total of 8464 cN⁺ and 4890 pN⁺ patients were identified. For cN⁺ disease, ADT alone was the most common treatment used (3892 patients, 46.0%) followed by RT with or without ADT (2657 patients, 31.4%). Men with older age, higher prostate-specific antigen at diagnosis, or higher biopsy Gleason score were less likely to receive curative treatment (RT or prostatectomy), whereas those with higher clinical T stage were more likely. For pN+ disease, 2948 patients (60.3%) received no adjuvant treatment and 833 patients (17.0%) received RT following prostatectomy. Patients with older age, negative margin, and comorbidities were less likely to undergo RT after prostatectomy, whereas those with higher pathologic T-stage were more likely. Conclusion: Many patients with cN⁺ or pN⁺ prostate cancer do not receive RT, despite the possibility of long-term control and cure. Randomized trials are needed to guide treatment decisions in this patient population.