Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Urol. 2020 May;203(5):933-939. doi: 10.1097/JU.0000000000000684. Epub 2020 Nov 20.
Surgical castration for metastatic prostate cancer is used less frequently than medical castration yet costs less, requires less followup and may be associated with fewer adverse effects. We evaluated temporal trends and factors associated with the use of surgical castration.
This retrospective cohort study sampled 24,805 men with newly diagnosed (de novo) metastatic prostate cancer from a national cancer registry in the United States (2004 to 2016). Multivariable logistic regression assessed the association between sociodemographic factors and surgery. Multivariable Cox regression evaluated the association between castration type and overall survival.
Overall 5.4% of men underwent surgical castration. This figure decreased from 8.5% in 2004 to 3.5% in 2016 (per year later OR 0.89, 95% CI 0.87-0.91, p <0.001). Compared to Medicare, private insurance was associated with less surgery (OR 0.73, 95% CI 0.61-0.87, p <0.001) while Medicaid or no insurance was associated with more surgery (OR 1.68, 95% CI 1.34-2.11, p <0.001 and OR 2.12, 95% CI 1.58-2.85, p <0.001, respectively). Regional median income greater than $63,000 was associated with less surgery (vs income less than $38,000 OR 0.61, 95% CI 0.43-0.85, p=0.004). After a median followup of 30 months castration type was not associated with differences in survival (surgical vs medical HR 1.02, 95% CI 0.95-1.09, p=0.6).
In a contemporary, real-world cohort surgical castration use is low and decreasing despite its potential advantages and similar survival rate compared to medical castration. Men with potentially limited health care access undergo more surgery, perhaps reflecting a provider bias toward the perceived benefit of permanent castration.
与药物去势相比,手术去势在转移性前列腺癌中的应用频率较低,但费用较低,随访需求较少,且可能与较少的不良反应相关。我们评估了手术去势的使用随时间的变化趋势及其相关因素。
本回顾性队列研究在美国国家癌症登记处(2004 年至 2016 年)中抽取了 24805 例新诊断(初发)转移性前列腺癌男性患者作为研究样本。多变量逻辑回归分析评估了社会人口因素与手术之间的关系。多变量 Cox 回归评估了去势类型与总生存之间的关系。
总体上,有 5.4%的男性接受了手术去势。这一数字从 2004 年的 8.5%下降到 2016 年的 3.5%(每年延迟的 OR 为 0.89,95%CI 为 0.87-0.91,p<0.001)。与医疗保险相比,私人保险与手术量较少相关(OR 0.73,95%CI 0.61-0.87,p<0.001),而医疗补助或无保险与手术量较多相关(OR 1.68,95%CI 1.34-2.11,p<0.001 和 OR 2.12,95%CI 1.58-2.85,p<0.001)。区域中位数收入超过 63000 美元与手术量减少相关(与收入低于 38000 美元相比 OR 0.61,95%CI 0.43-0.85,p=0.004)。在中位随访 30 个月后,去势类型与生存无差异(手术与药物去势 HR 1.02,95%CI 0.95-1.09,p=0.6)。
在当代真实世界的队列中,尽管手术去势具有潜在优势且与药物去势的生存率相似,但手术去势的应用率较低且呈下降趋势。可能存在有限的医疗保健机会的男性接受了更多的手术,这可能反映了提供者对永久性去势的潜在益处的偏见。