Hospitalizations to Manage Complications of Modern Prostate Cancer Treatment in Older Men

Objective To assess rates of treatment-related hospitalizations following surgery and radiotherapy in the treatment of clinically localized prostate cancer, given the importance of hospitalizations in healthcare resource utilization. Methods We conducted a population-based retrospective cohort study of patients aged 65-79 years receiving radical prostatectomy (open or minimally invasive) or radiotherapy (brachytherapy or external beam) from 2001 to 2008 in the Surveillance, Epidemiology & End Results-Medicare linked databases. We assessed treatment-related hospitalizations. We analyzed the role of primary treatment on the number of complications per patient in each category using negative binomial regression. Results Among 60,476 men, 14,492 underwent primary surgery and 45,984 underwent primary radiotherapy. Over a median follow-up of 5.6 years, the surgery group had significantly lower rates of hospital admissions (8.9 vs 20.3/1000 person-years) than the radiation group. For both groups, admissions peaked within 2 years of treatment, but continued at a steady rate for 10 years. After adjustment for confounders, patients treated with radiation had higher incidence of hospital admissions (relative rate [RR] = 1.8, 95% confidence interval [CI]: 1.8-1.9, P < .0001), compared to those having surgery. Stratified analysis showed an increased rate of hospitalizations of 1 day and 2 or more days (RR 3.1, 95% CI: 2.7-3.7 and RR 1.6, 95% CI 1.4-1.8, respectively) for patients treated with radiotherapy. The use of adjuvant/salvage therapies significantly increased rates of hospitalization. The results were robust to analysis using propensity-score matching. Conclusion Treatment-related hospitalizations are more common following radiotherapy than surgery in the treatment of clinically localized prostate cancer. Limitations include a lack of treatment detail and residual confounding due to observational study design.