Sharp Decline In Prostate Cancer Treatment Among Men In The General Population, But Not Among Diagnosed Men.

The indolent nature of many prostate cancers has heightened concerns that harms from treatment may outweigh those from the disease and has resulted in a growing consensus in favor of less aggressive screening and treatment. We sought to understand the population-level impact of this consensus on the treatment of prostate cancer. Using national Medicare data for the period 2007-12, we assessed treatment rates among men with newly diagnosed prostate cancer. We identified both population-based rates (which are sensitive to changes in diagnosis and treatment patterns) and rates among diagnosed men (which are sensitive only to changes in treatment patterns). We also assessed trends in treatment among men with a high risk of noncancer mortality, who are unlikely to benefit from treatment. Population-based treatment rates declined by 42 percent, while rates among diagnosed men declined by only 8 percent. Treatment rates among men with the highest noncancer mortality risk and regional variation were unchanged. These results suggest that decreasing rates of diagnosis, changing attitudes, and guidelines calling for reduced prostate-specific antigen screening, not changes in practice patterns among specialists treating diagnosed men, drove the decline in population-based treatment rates. Compared to policies that emphasize volume, those that emphasize value in specialty care have the potential to exert stronger effects on practice patterns.