Residential location shapes initial prostate cancer care in Korea (2010-2020): A nationwide stage- and risk-stratified study.

PURPOSE: To characterize nationwide patterns of initial prostate cancer (PCa) management in Korea from 2010 to 2020, stratified by clinical stage, risk, and residential context. MATERIALS AND METHODS: We performed a secondary analysis of a chart-abstracted cohort from 51 general hospitals. Initial treatment was classified into ten mutually exclusive categories (active surveillance; surgery; surgery after androgen deprivation therapy [ADT]; radiotherapy; radiotherapy after ADT; docetaxel after ADT; androgen receptor-targeted agent [ARTA] after ADT; ADT-only ≥1 year; other active treatment; unknown). Localized disease (T1-T4N0M0) was stratified by risk (low, intermediate, and high). Residential context was coded as capital versus non-capital and urban versus rural. National Comprehensive Cancer Network risk stratification (version 2.2024) was applied uniformly across survey years. RESULTS: Among 27,075 men, initial management differed significantly by stage, risk, and residence. In localized disease, surgery predominated, active surveillance was most frequent in low-risk disease, and radiotherapy and ADT-only increased with higher risk (p<0.001). Over time, ADT-only decreased in metastatic disease, with increases in radiotherapy and systemic intensification (p=0.004). Capital and urban residence were associated with greater use of surgery in localized disease and systemic intensification in metastatic disease, whereas non-capital and rural residence relied more on ADT-only (all p<0.001). In multivariable analyses, residential context remained independently associated with treatment selection after adjustment for age, prostate-specific antigen, grade, and stage. CONCLUSIONS: Initial PCa management in Korea during the 2010s reflected contemporary adoption of surgical and systemic therapies but demonstrated persistent geographic variation, indicating residential context influences real-world access to guideline-concordant care.