The treatment patterns of non-metastatic prostate cancer in an Asian country

[[abstract]]Introduction and objectives: The aim of the study is to analyze the treatment patterns of non-metastatic prostate cancer in Taiwan, a highly-developed Asian country with a very unique national healthcare system covered near 100% of the national population. Materials and methods: Analyses were made from 64 high-volume hospitals with data contributed to the National Cancer Registry Database, Taiwan from 1998 – 2012, which represented > 70% of annual prostate cancer patients. Patients with localized (stage I-II, AJCC 7th ed., 2002) or locally advanced (AJCC stage III) prostate cancer were further investigated. The distribution of primary treatment modalities was measured. The descriptive analysis was performed. The patterns of treatment were compared between patients younger or older than 75 years and hospitals with patient numbers less or more than 250 from 1998 – 2012. The annual trends of the treatment patterns were also investigated. Results: In total, 10 050 patients were analyzed in the 5 year period with 8115 (80.7%) localized and 1935 (19.3%) locally advanced disease. The treatment modalities were 2971 (29.6%) external-beam radiation (EBT), 2782 (27.7%) radical prostatectomy (RP), 2504 (24.9%) primary hormonal therapy (PHT), 870 (8.7%) transurethral resection of prostate (TURP) only, 404 (4.0%) watchful waiting (WW), and 399 (4.0%) cryoablation. Among patients with localized disease, 26.4% elected EBT, 29.2% RP, 24.7% PHT, 10.4% TURP only, 4.6% WW, and 3.3% cryoablation. For those with locally advanced disease, 42.8% elected EBT, 21.1% RP, 26.0% PHT, 1.2% TURP only, 1.3% WW, and 6.9% cryoablation. There are signi fi cant differences (P < 0.0001) between the main treatment modalities between localized and locally advanced disease except PHT. After stratifying patients by age (cutoff of 75 years) and patient volume (cutoff of 250 cases in 5 years), signi fi cant differences were observed between the main treatment choices including RP, EBT, PHT, TURP only, and WW forlocalized disease. The differences were signi fi cant in RP, PHT, cryoablation between patients younger or older than 75 years and RP, EBT, PHT, and cryoablation between hospitals with patient numbers less or more than 250 for locally advanced disease. Conclusion: In this Asian country with a very high accessibility of healthcare system, the choices of treatment modalities for localized and locally advanced disease were significantly different. Age and patient volumes were important determining factors for the treatment choices of both localized and locally advanced prostate cancer. Such information was invaluable in the Asian society which would provide valuable references