Hoffman, Karen C., Jiangong Niu, Sharon H. Giordano, Vivian Ho, Benjamin D. Smith (2013), "Prostate Cancer Treatment Patterns in the State of Texas, 2004-2007." Texas Public Health Association Journal, 65(2), 37-44. 

BACKGROUND: Understanding current patterns of prostate cancer treatment in Texas is critically important in order to develop public health strategies to ensure appropriate treatment of unfavorable disease while discouraging inappropriate treatment of favorable disease. Yet to date, little is known regarding prostate cancer treatment patterns in Texas. Accordingly, we conducted the first population-based study of prostate cancer treatment patterns using the Texas Cancer Registry (TCR) data linked to patient Medicare claims. 
METHODS: We identified a total of 11,877 men residing in Texas, age 66 and older, who were diagnosed with incident prostate cancer from 2004 to 2007 and had fee-for-service Medicare coverage. TCR data classified patients as favorable risk (T1 or T2, low grade) versus unfavorable risk (T3 or T4 or high grade). Cancer treatment within one year of diagnosis was determined using TCR data and Medicare billing claims. Chi-square test evaluated for unadjusted associations between risk group and treatment, and multivariate logistic regression identified factors associated with observation in men with favorable disease and inappropriate omission of treatment in men with unfavorable disease.
RESULTS: A total of 45% of men had favorable disease and 51% had unfavorable disease. Treatment was given to 86% of men with favorable disease and 94% of men with unfavorable disease (p<0.001). The most common treatment was external beam radiation (35% of cohort) followed by radical prostatectomy (27% of cohort). Among men with favorable disease, advanced age, comorbid illness, diagnosis in 2007, and consultation with an urologist only (compared to an urologist and radiation oncologist) were associated with increased odds of observation. Among men with unfavorable disease, advanced age, black race, and consultation with an urologist only (compared to an urologist and radiation oncologist) were associated with increased odds of inappropriate omission of cancer treatment.
CONCLUSION: The vast majority of older men diagnosed with prostate cancer in Texas receive cancer-directed treatment. Efforts are needed to decrease use of cancer-directed treatment in older men with favorable disease while preserving the high treatment rate in older men with unfavorable disease.