Radical Prostatectomies -- Wisconsin, 1982-1992

Prostate cancer incidence and death rates have increased during the past decade in the United States (1). In addition, a recent study of the Medicare population indicated that the rate of radical prostatectomies (the removal of the prostate gland, ejaculatory ducts, and seminal vesicles) increased nearly sixfold from 1984 through 1990 (2). To examine trends in prostate cancer incidence and surgical treatment in Wisconsin, the Wisconsin Division of Health assessed data from 1982 through 1992. This report summarizes the results of this study.

Data on new cases of prostate cancer from 1982 through 1991 (the last year for which data were available) were obtained from the Wisconsin cancer reporting system (3). Radical prostatectomies for 1982 and 1986 were estimated from hospital discharge surveys from a representative sample of all Wisconsin hospitals (4,5). Data on radical prostatectomies from 1989 through 1992 were obtained from the Wisconsin hospital discharge data base, along with data on the patient's age, length of the hospitalization, source of payment, admitting physician, hospital charges, and hospital size. Radical prostatectomy was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification, procedure code 60.5 (radical prostatectomy).

From 1982 through 1991, the incidence rate (age-adjusted in 5-year age groups to the 1970 U.S. population) for prostate cancer in Wisconsin increased by approximately 60%, from 77.3 to 123.8 per 100,000 men. During the same period, the age-adjusted incidence rate for radical prostatectomies increased 13-fold, from 3.0 per 100,000 men during 1982 to 38.7 in 1991 (Figure 1).

The number of radical prostatectomies performed annually during 1989-1992 increased nearly fourfold, from 384 to 1373 (Table 1). Fifty-eight percent of men treated with surgery were aged 65-74 years, and 6% were aged greater than or equal to 75 years. Large hospitals * performed approximately 90% of these procedures. Although the average length of stay for a radical prostatectomy decreased steadily, the average charge for each hospitalization increased 9% (adjusted to 1989 U.S. dollars). Total hospital charges for radical prostatectomies increased nearly fourfold from 1989 through 1992 (excluding the cost of postsurgical complications and their treatment) and were approximately $13.5 million for 1992. Medicare insured approximately 60% of all patients.

From 1989 through 1992, the number of physicians performing radical prostatectomies in Wisconsin increased 17%, and the median number of procedures performed by each physician each year increased from two to seven (Table 1). Twenty-six (20%) physicians performed radical prostatectomies more than 20 times in 1992, and these were responsible for 691 (50%) of all such procedures.

Reported by: R Bruskewitz, MD, Dept of Urology, Univ of Wisconsin Medical School, Madison; L Harms, JL Phillips, MA, Center for Health Statistics, PL Remington, MD, State Chronic Disease Epidemiologist, HA Anderson, MD, State Environmental Epidemiologist, Bur of Public Health, Div of Health, Wisconsin Dept of Health and Social Svcs. Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Radical prostatectomy is the only surgical treatment for prostate cancer and is not used for any other condition. Radical prostatectomy is considered curative for men with cancer contained within the prostate capsule (6). However, it is unclear whether surgical treatment of these patients improves their survival, and some physicians advocate alternatives for the management of organ-confined prostate cancer (6,7). Men treated with radical prostatectomy may die intraoperatively or postoperatively (1%-2%), and impotence (25%), urinary stricture (18%), urinary incontinence (6%), and rectal injury (3%) are complications of the procedure (8).

This report documents a substantial increase in the number of radical prostatectomies performed in Wisconsin during the past 11 years -- several times the increase in prostate cancers diagnosed -- indicating that an increasing proportion of men in whom prostate cancer is diagnosed are treated surgically. Although the benefits of an increasing frequency of surgery in the treatment of prostate cancer are unknown (9), the human and economic costs of this increase are high. The effectiveness of available treatment options should be carefully evaluated so that patients can be informed of risks and benefits of alternative treatments (5,9).

References

1. CDC. Trends in prostate cancer -- United States, 1980-1988. MMWR 1992;41:401-4.

2. Lu-Yao GL, McLerran D, Wasson J, Wennberg JE. An assessment of radical prostatectomy. JAMA 1993;269:2633-6.

3. Wisconsin Cancer Reporting System. Cancer in Wisconsin, 1991. Wisconsin Department of Health and Social Services, Center for Health Statistics, 1991; publication no. POH-5154.

4. Wisconsin Department of Health and Social Services. Wisconsin hospital discharge report: 1986 morbidity, patient characteristics and utilization. Wisconsin Department of Health and Social Services, Division of Health, 1983; publication no. POH-5020.

5. Wisconsin Department of Health and Social Services. Wisconsin hospital discharge report: morbidity, patient characteristics and utilization. Wisconsin Department of Health and Social Services, Division of Health, 1987; publication no. POH-5055.

6. Badalament RA, Drago JR. Prostate cancer. Dis Mon 1991;37:233.

7. Johansson JE, Adami HO, Andersson SE, Bergstrom R, Holmberg L, Krusemo UB. High 10-year survival rate on patients with early, untreated prostatic cancer. JAMA 1992;267:2191-6.

8. Optenberg S, Thompson IM. Economics of screening for carcinoma of the prostate. Urol Clin North Am 1990;17:719-37.

9. Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg JE. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA 1993;269:2650-6.

• Hospitals were ranked according to the number of discharges and divided into three equal groups.

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