Presentation Authors: Peter Reisz*, NASHVILLE, TN, Zhiguo Zhao, Nashville, TN, TN, Li-Ching Huang, Tatsuki Koyama, NASHVILLE, TN, Karen Hoffman, Houston, TX, Ralph Conwill, David Penson, Daniel Barocas, NASHVILLE, TN
Introduction: Previous studies have suggested that there is racial, geographic, and socioeconomic variation in outcomes for localized prostate cancer, which raises concern for disparities in quality of care. Using a prospective, population-based cohort, we sought to measure clinically relevant variation in structure, process, and outcome measures across racial groups, age groups, surgical approach, and surgeon volume.
Methods: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) Study enrolled 1,523 men with clinically localized prostate cancer diagnosed between 2011 and 2012 who underwent radical prostatectomy, of whom 1,069 met final inclusion criteria. Quality of life was assessed using the EPIC-26, and clinical data were collected by chart review. Six quality measures were assessed: lymphadenectomy when risk of lymph node involvement â‰¥ 2%, nerve-sparing among men with Dâ€™Amico low-risk disease and good baseline sexual function, negative surgical margins, urinary and sexual function outcomes, treatment by a high-volume surgeon (>10 cases in cohort), and 30-day and one-year complications. Receipt of high quality care was compared across categories of race, age, surgeon volume, and surgical approach.
Results: Table 1 shows the proportion meeting each dichotomous quality measure across exposure groups. There were no significant differences in quality between white and African-American patients, among age groups, or across strata of surgeon volume. However, robotic surgery patients were less likely to undergo lymphadenectomy when indicated, and less likely to be treated by a high-volume surgeon. Patients undergoing open surgery had significantly more short and long term complications and had worse sexual function over time.
Conclusions: We found no evidence of variation in surgical quality by race, age, or surgeon volume strata. However, we did find variation between open and robotic surgery. We found lower use of indicated lymphadenectomy in the robotic group, possibly reflecting a quality deficit, a difference in practice pattern, or early adoption of higher thresholds for lymphadenectomy. Lower use of high-volume surgeons in the robotic group may reflect the wide dissemination of this technique, with few high-volume surgeons still performing open prostatectomy.