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 early prostate cancer has led to subsequent increased application of curative treatment and whether similar patterns of treatment were observed in the various hospitals in the area of this investigation. Methods: Using the Eindhoven Cancer Registry, all patients newly diagnosed with prostate cancer between 1988 and 1996 in the southern part of The Netherlands were included in the study. Initial treatment was analyzed for 4,073 patients, of whom the proportion with clinically localized prostate cancer (T1-T3, M0-Mx) increased from 52% in 1988-1990 to 74% in 1994-1996. Results: The proportion of patients with localized prostate cancer treated with radical prostatectomy increased from 11 to 34% among patients under age 70. Especially in 1994-1996, a group of smaller hospitals (n = 11) with a rather low proportion of patients treated by radical prostatectomy (5-52%) could be distinguished from a group of larger hospitals (n = 5) with a large proportion of patients treated by radical prostatectomy (35-67%). Radiotherapy was a more frequent option 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 conservatively during the whole study period. Conclusion: Increased detection of localized prostate cancer resulted in increased application of curative treatment for patients under 70 years of age, but a substantial variation was observed between hospitals in the application of radical prostatectomy and radiotherapy.