Treatment at a radiation facility that had a high level of experience treating patients with prostate cancer was associated with longer patient survival, a retrospective cohort study in JAMA Network Open found.

Using the National Cancer Database, the study authors identified patients with node-positive prostate cancer who received external beam radiation therapy in combination with androgen deprivation therapy between January 2004 and December 2016.

For each patient, the study authors calculated the cumulative facility volume, which was defined as the number of radiation cases at a patient’s radiation facility between 2004 and the year of the patient’s diagnosis.

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Next, the cumulative facility volume for each patient was divided by the number of years that the facility reported to the National Cancer Database until the year of the patient’s diagnosis. This value was the average cumulative facility volume (ACFV) for a patient.

The study authors explained that the ACFV represents the experience level of the treating facility at the time that specific patient received treatment.

The analysis included 1899 patients, of whom 1114 were treated at a low-ACFV facility and 785 at a high-ACFV center.

Patients who were treated at a high-ACFV location lived a median of nearly 19 months longer than patients treated at a low-ACFV site of care (111.1 vs 92.3 months; P =.01), and this benefit persisted when adjusted by inverse probability score weighting (111.1 vs 94.5 months; P =.04). A multivariate analysis showed that patients treated at a low-ACFV facility had an elevated risk of death compared with patients treated at a high-ACFV establishment (hazard ratio, 1.22; 95% CI, 1.02-1.46; P =.03).

The study authors described their findings as “hypothesis-generating,” and listed several study limitations, including the retrospective nature of the analysis and lack of information in the database about toxicity, quality of life, and duration of androgen deprivation therapy.

“Further studies should focus on identifying which factors unique to high-volume centers may be responsible for this benefit,” the study authors wrote.


Patel SA, Goyal S, Liu Y, et al. Analysis of radiation facility volume and survival in men with lymph node-positive prostate cancer treated with radiation and androgen deprivation therapy. JAMA Netw Open. 2020;3(12):e2025143. doi:10.1001/jamanetworkopen.2020.25143