Trend and variation in treatment of localized prostate cancer in the southern part of The Netherlands, 1988-1996

Objective: To investigate whether the large increase in the incidence of ea rly prostate cancer has led to subsequent increased application of curative treatment and whether similar patterns of treatment were observed in the v arious hospitals in the area of this investigation. Methods: Using the Eind hoven Cancer Registry, all patients newly diagnosed with prostate cancer be tween 1988 and 1996 in the southern part of The Netherlands were included i n the study. Initial treatment was analyzed for 4,073 patients, of whom the proportion with clinically localized prostate cancer (T1-T3, M0-Mx) increa sed from 52% in 1988-1990 to 74% in 1994-1996. Results: The proportion of p atients with localized prostate cancer treated with radical prostatectomy i ncreased from 11 to 34% among patients under age 70. Especially in 1994-199 6, a group of smaller hospitals (n = 11) with a rather low proportion of pa tients treated by radical prostatectomy (5-52%) could be distinguished from a group of larger hospitals (n = 5) with a large proportion of patients tr eated by radical prostatectomy (35-67%). Radiotherapy was a more frequent o ption in hospitals with low radical prostatectomy rates. The proportion of patients aged 70-74 years undergoing radiotherapy increased from 31 to 41%. Over 80% of the patients aged 75 years or older were treated conservativel y during the whole study period. Conclusion: Increased detection of localiz ed prostate cancer resulted in increased application of curative treatment for patients under 70 years of age, but a substantial variation was observe d between hospitals in the application of radical prostatectomy and radioth erapy.