USE OF RADICAL PROSTATECTOMY AMONG MEDICARE BENEFICIARIES BEFORE AND AFTER THE INTRODUCTION OF PROSTATE-SPECIFIC ANTIGEN TESTING

Purpose: We monitored the use of radical prostatectomy in medicare ben eficiaries before and after the introduction of prostate specific anti gen (PSA) testing. Materials and Methods: Radical prostatectomies perf ormed on medicare beneficiaries between 1984 and 1995 were identified through the medicare claims data base. Medicare enrollment files were used to define the population at risk and age-adjusted rates were stan dardized to the 1990 United States medicare population. Results: Rates of radical prostatectomy have steadily increased since 1984. A sharp increase in radical prostatectomy rates followed the institution of PS A testing after which a prominent decrease, particularly among older a ge groups, was evident. During the peak year of 1992 the age-adjusted rates of radical prostatectomy for white and black men 65 to 79 years old in the United States were 461.2 and 294.5/100,000 men. Between 199 2 and 1995 the rates of radical prostatectomy among white men decrease d by 22, 47 and 69% for patients 65 to 69, 70 to 74 and 75 to 79 years old, respectively. The corresponding changes among black men were +6, -18 and -47%, respectively. Differences in the age-adjusted rates bet ween white and black men have narrowed in recent years, ranging from 1 66.7 (1992) to 29.7 (1995)/100,000 men. Conclusions: Recent years have been marked by a rapid increase in the use of radical prostatectomy, which peaked in 1992. Subsequent to 1992 a sharp decrease occurred, wh ich was particularly evident in older and white men. Racial difference s in the use of radical prostatectomy have narrowed in recent years.