SECULAR CHANGES IN RADICAL PROSTATECTOMY UTILIZATION RATES IN OLMSTEDCOUNTY, MINNESOTA 1980 TO 1995

Purpose: We estimated the changes in utilization of radical prostatect omy for treatment of prostate cancer and describe the clinical charact eristics of men undergoing radical prostatectomy in a population based setting. Materials and Methods: The Rochester Epidemiology Project wa s used to identify all Olmsted County residents who underwent radical prostatectomy from 1980 to 1995. The community medical records of thes e men were reviewed to determine the clinical and pathological stage a nd grade at biopsy and following surgery. Results: From 1980 to 1995, 311 radical prostatectomies were performed on Olmsted County men. From 1980 to 1987 prostatectomy rates ranged from 6.3 to 31.0/100,000 men but rates increased dramatically to 53.6/100,000 in 1988 and 106.2/100 ,000 in 1992. The rate after 1992 decreased to 53.0/100,000 and then i ncreased slightly to 80.4/100,000, There was a shift to younger age in more recent times (mean patient age 65.4 years in 1980 to 1986 and 62 .4 in 1993 to 1995, p = 0.02), a nonsignificant (p = 0.10) trend towar d lower pathological stage in recent years (42% stage pT2 in 1980 to 1 986 versus 55% in 1993 to 1995) and a significant decrease in the prop ortion of cases of disease up staged following surgery (53% in 1980 to 1986 versus 37% in 1993 to 1995, p = 0.03). There was no significant trend in pathological grade with time (63% Mayo grade I or II in 1980 to 1986 versus 52% in 1993 to 1995, p = 0.30). Conclusions: These find ings demonstrate an increase in radical prostatectomy rates that coinc ided with increases in prostate cancer incidence. There was a decrease in population prostatectomy rates in 1993 which was followed by modes t increases to levels lower than the peak in 1992. However, the clinic al characteristics of patients during this period did net change drama tically, suggesting that in a population based setting the selection f actors for patients undergoing surgical treatment may not have changed .