To examine the effect of urology practice market competition on use of treatment in men with newly diagnosed prostate cancer.
We performed a retrospective national cohort study of 48,067 Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2018. The primary exposure was urology practice-level market competition. Markets were established by the flow of patients to a practice using a variable radius approach. Practice level competition was measured annually using the Herfindahl-Hirschman Index (HHI). The primary outcome was use of treatment for prostate cancer (i.e., surgery, radiation, or cryotherapy) stratified by 10-year risk of non-cancer mortality.
Between 2014 and 2018, there was a decrease in the total percent of urologists practicing in small single specialty groups (49% to 41%) with an increase in multispecialty practices (38% to 47%). After adjusting for demographic and clinical characteristics, a lower percentage of men underwent treatment in practices with low competition relative to those managed in practices with high competition (70% vs 67.0%, p <0.001). Among men with the highest risk of non-cancer mortality, those managed in practices in the least competitive markets were less likely to receive treatment relative to men managed by practices in the most competitive markets (48% vs. 60%, p-value <0.001).
Reduction in competition between urology practices is not associated with greater use of treatment in men with newly diagnosed prostate cancer, particularly in those with a high risk of non-cancer mortality.

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