Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Research

Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany: a comparative population-based study

Prostate Cancer and Prostatic Diseases volume 20, pages 61–66 (2017)Cite this article

Subjects

Abstract

Background:

Current guidelines do not recommend a preferred treatment modality for locally advanced prostate cancer. The aim of the study was to compare treatment patterns found in the USA and Germany and to analyze possible trends over time.

Methods:

We compared ‘Surveillance Epidemiology and End Results’ (SEER) data (USA) with reports from four German federal epidemiological cancer registries (Eastern Germany, Bavaria, Rhineland-Palatinate, Schleswig-Holstein), both from 2004 to 2012. We defined locally advanced prostate cancer as clinical stage T3 or T4. Exclusion criteria were metastatic disease and age over 79 years.

Results:

We identified 9127 (USA) and 11 051 (Germany) patients with locally advanced prostate cancer. The share was 2.1% in the USA compared with 6.0% in Germany (P<0.001). In the United States, the utilization of radiotherapy (RT) and radical prostatectomy (RP) was comparably high with 42.0% (RT) and 42.8% (RP). In Germany, the major treatment option was RP with 36.7% followed by RT with 22.1%. During the study period, the use of RP increased in both countries (USA P=0.001 and Germany P=0.003), whereas RT numbers declined (USA P=0.003 and Germany P=0.002). The share of adjuvant RT (aRT) was similar in both countries (USA 21.7% vs Germany 20.7%).

Conclusion:

We found distinctive differences in treating locally advanced prostate cancer between USA and Germany, but similar trends over time. In the last decade, a growing number of patients underwent RP as a possible first step within a multimodal concept.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Hodgson D, Warde P, Gospodarowicz M . The management of locally advanced prostate cancer. Urol Oncol 1998; 4: 3–12.

    Article  CAS  Google Scholar 

  2. Sridharan S, Dal Pra A, Catton C, Bristow RG, Warde P . Locally advanced prostate cancer: current controversies and optimisation opportunities. Clin Oncol (R Coll Radiol) 2013; 25: 499–505.

    Article  CAS  Google Scholar 

  3. Bach C, Pisipati S, Daneshwar D, Wright M, Rowe E, Gillatt D et al. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol 2014; 11: 342–351.

    Article  Google Scholar 

  4. Ward JF, Slezak JM, Blute ML, Bergstralh EJ, Zincke H . Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int 2005; 95: 751–756.

    Article  Google Scholar 

  5. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014; 65: 124–137.

    Article  Google Scholar 

  6. Etzioni R, Gulati R, Falcon S, Penson DF . Impact of PSA screening on the incidence of advanced stage prostate cancer in the United States: a surveillance modeling approach. Med Decis Making 2008; 28: 323–331.

    Article  Google Scholar 

  7. Carlsson S, Vickers AJ, Roobol M, Eastham J, Scardino P, Lilja H et al. Prostate cancer screening: facts, statistics, and interpretation in response to the US Preventive Services Task Force Review. J Clin Oncol 2012; 30: 2581–2584.

    Article  Google Scholar 

  8. Stewart SB, Boorjian SA . Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective. Urol Oncol 2015; 33: 235–244.

    Article  Google Scholar 

  9. Hager B, Kraywinkel K, Keck B, Katalinic A, Meyer M, Zeissig SR et al. Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: A comparison of treatment trends in the United States and Germany from 2004 to 2011. Radiother Oncol 2015; 115: 90–95.

    Article  Google Scholar 

  10. Lau EC, Mowat FS, Kelsh MA, Legg JC, Engel-Nitz NM, Watson HN et al. Use of electronic medical records (EMR) for oncology outcomes research: assessing the comparability of EMR information to patient registry and health claims data. Clin Epidemiol 2011; 3: 259–272.

    PubMed  PubMed Central  Google Scholar 

  11. Jani AB, Johnstone PAS, Liauw SL, Master VA, Rossi PJ . Prostate cancer modality time trend analyses from 1973 to 2004: a surveillance, epidemiology, and end results registry analysis. Am J Clin Oncol 2010; 33: 168–172.

    PubMed  Google Scholar 

  12. Scosyrev E, Messing J, Noyes K, Veazie P, Messing E . Surveillance Epidemiology and End Results (SEER) program and population-based research in urologic oncology: an overview. Urol Oncol 2012; 30: 126–132.

    Article  Google Scholar 

  13. Giordano SH, Kuo Y-F, Duan Z, Hortobagyi GN, Freeman J, Goodwin JS . Limits of observational data in determining outcomes from cancer therapy. Cancer 2008; 112: 2456–2466.

    Article  Google Scholar 

  14. Lowrance WT, Elkin EB, Yee DS, Feifer A, Ehdaie B, Jacks LM et al. Locally advanced prostate cancer: a population-based study of treatment patterns. BJU Int 2012; 109: 1309–1314.

    Article  Google Scholar 

  15. Pilepich MV, Winter K, Lawton CA, Krisch RE, Wolkov HB, Movsas B et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma—long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 2005; 61: 1285–1290.

    Article  CAS  Google Scholar 

  16. Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 2010; 11: 1066–1073.

    Article  CAS  Google Scholar 

  17. Wolff RF, Ryder S, Bossi A, Briganti A, Crook J, Henry A et al. A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. Eur J Cancer 2015; 51: 2345–2367.

    Article  Google Scholar 

  18. Wirth MWL, Ackermann R et al. Interdisciplinary guideline of quality S3 for early detection, diagnosis and treatment of different stages of prostate cancer. (Guideline in German) 2011. (e-pub ahead of print; doi:10.1038/pcan.2016.34).

  19. Carver BS, Bianco FJ Jr., Scardino PT, Eastham JA . Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. J Urol 2006; 176: 564–568.

    Article  Google Scholar 

  20. Hsu CY, Joniau S, Oyen R, Roskams T, Van Poppel H . Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience. Eur Urol 2007; 51: 121–128; discussion 128–129.

    Article  Google Scholar 

  21. Thompson IM Jr., Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 2006; 296: 2329–2335.

    Article  CAS  Google Scholar 

  22. Walz J, Joniau S, Chun FK, Isbarn H, Jeldres C, Yossepowitch O et al. Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy. BJU Int 2011; 107: 765–770.

    Article  Google Scholar 

  23. Yossepowitch O, Eggener SE, Serio AM, Carver BS, Bianco FJ Jr., Scardino PT et al. Secondary therapy, metastatic progression, and cancer-specific mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy. Eur Urol 2008; 53: 950–959.

    Article  Google Scholar 

  24. Orvieto MA, Patel VR . Evolution of robot-assisted radical prostatectomy. Scand J Surg 2009; 98: 76–88.

    Article  CAS  Google Scholar 

  25. Siemer S, Stockle M . Robotic medicine in Germany: quo vadis? [article in German]. Urologe 2011; 50: 928–931.

    Article  CAS  Google Scholar 

  26. Groeben C, Koch R, Baunacke M, Wirth MP, Huber J . Robots drive the German radical prostatectomy market: a total population analysis from 2006 to 2013. Prostate Cancer and Prostatic Diseases 2016; e-pub ahead of print 23 August 2016.

  27. Schroeck FR, Kaufman SR, Jacobs BL, Zhang Y, Weizer AZ, Montgomery JS et al. The impact of technology diffusion on treatment for prostate cancer. Med Care 2013; 51: 1076–1084.

    Article  Google Scholar 

  28. Ham WS, Park SY, Rha KH, Kim WT, Choi YD . Robotic radical prostatectomy for patients with locally advanced prostate cancer is feasible: results of a single-institution study. J Laparoendosc Adv Surg Tech A 2009; 19: 329–332.

    Article  Google Scholar 

  29. Vora AA, Marchalik D, Kowalczyk KJ, Nissim H, Bandi G, McGeagh KG et al. Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes. Prostate Int 2013; 1: 31–36.

    Article  Google Scholar 

  30. Jang TL, Bekelman JE, Liu Y, Bach PB, Basch EM, Elkin EB et al. Physician visits prior to treatment for clinically localized prostate cancer. Arch Intern Med 2010; 170: 440–450.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Professor Rainer Koch for statistical advice. Parts of this study were presented at the Annual Meeting of the European Association of Urology in 2015.

Author information

Authors and Affiliations

  1. Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany

    B Hager, M P Wirth & J Huber

  2. National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany

    K Kraywinkel

  3. Department of Urology, University Hospital Erlangen, Erlangen, Germany

    B Keck

  4. Institute of Clinical Epidemiology, University Hospital Schleswig-Holstein, Lübeck, Germany

    A Katalinic

  5. Population-Based Cancer Registry, Bavaria, Nuremberg, Germany

    M Meyer

  6. Cancer Registry Rhineland-Palatinate, Mainz, Germany

    S R Zeissig

  7. Common Cancer Registry of The Federal States Berlin/Brandenburg/Mecklenburg-Vorpommern/Sachsen-Anhalt/Sachsen/Thüringen, Berlin, Germany

    R Scheufele

Authors
  1. B Hager
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Kraywinkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Keck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Katalinic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S R Zeissig
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Scheufele
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M P Wirth
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J Huber.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hager, B., Kraywinkel, K., Keck, B. et al. Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany: a comparative population-based study. Prostate Cancer Prostatic Dis 20, 61–66 (2017). https://doi.org/10.1038/pcan.2016.43

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2016.43

This article is cited by

Search

Advanced search

Quick links