PERFORMANCE OF MULTIGENE PANEL TESTING IN HEREDITARY PROSTATE CANCER

localized low-risk PCa and who are both older than 65 years of age and have a limited life expectancy (<10 years).METHODS: Using data from the National Cancer Data Base, we identified 24,077 men >65 years of age with limited life expectancy receiving definitive therapy at 1,172 Commission on Cancer accredited facilities for biopsy confirmed localized low risk PCa diagnosed between January 2004 and December 2013.A multilevel hierarchical mixed-effects logistic regression model with a random effect to capture potential facility clustering was fitted to predict the odds of receiving definitive therapy.RESULTS: Overall, 18,178 (76%) men >65 years of age with a limited life expectancy and a diagnosis of low-risk prostate cancer received definitive therapy.Patients receiving definitive therapy were more often younger (66-69 vs. 80+: OR 0.12, 95% CI 0.09-0.15;p<0.001) and White rather than Black (OR 0.86, 95% CI 0.75-0.98;p¼0.03).Conversely, being uninsured (OR 0.37, 95% CI 0.21-0.63;p<0.001) and receiving care at an academic medical center (OR 0.36, 95% CI 0.28-0.46;p<0.001) conferred decreased odds of undergoing definitive therapy.The proportion of men undergoing definitive therapy ranged from 0.12% to 100% among the 1,172 institutions included in our analysis.CONCLUSIONS: After adjusting for sociodemographic and clinical factors, we found significant facility-level variation in rates of definitive therapy for men with localized PCa and limited life expectancy.Health care providers and policy makers alike should be aware of the varying frequency with which this potentially low value service is performed, particularly in the setting of looming value-based payment reform efforts.