Variation in treatment associated with life expectancy in a population-based cohort of men with early-stage prostate cancer - Abstract

BACKGROUND: Men with major comorbidities are at risk for overtreatment of prostate cancer due to uncertainty regarding their life expectancy.

We sought to characterize life expectancy and treatment in a population-based cohort of men with differing ages and comorbidity burdens at diagnosis.

METHODS: We sampled 96,032 men aged ≥66 years with early-stage prostate cancer who had Gleason scores ≤ 7 and were diagnosed during 1991 to 2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We calculated cumulative incidence of other-cause mortality and determined treatment patterns among subgroups defined by age and Charlson comorbidity index scores.

RESULTS: Overall, life expectancy was < 10 years (10-year other-cause mortality rate, >50%) for 50,049 of 96,032 men (52%). Life expectancy differed by age and comorbidity score and was < 10 years for men ages 66 to 69 years with Charlson scores ≥2, for men ages 70 to 74 years with Charlson scores ≥1, and for all men ages 75 to 79 years and ≥80 years. Among those who had a life expectancy < 10 years, treatment was aggressive (surgery, radiation, or brachytherapy) for 68% of men aged 66 to 69 years, 69% of men aged 70 to 74 years, 57% of men aged 75 to 79 years, and 24% of men aged ≥80 years. Among these men, aggressive treatment was predominantly radiation therapy (50%, 53%, 63%, and 69%, respectively) and less frequently was surgery (30%, 25%, 13%, and 9%, respectively). Multivariate models revealed little variation in the probability of aggressive treatment by comorbidity status within age subgroups despite substantial differences in mortality.

CONCLUSIONS: Men aged < 80 years at diagnosis who have life expectancies < 10 years often receive aggressive treatment for low-risk and intermediate-risk prostate cancer, mostly with radiation therapy.

Written by:
Daskivich TJ, Lai J, Dick AW, Setodji CM, Hanley JM, Litwin MS, Saigal C.   Are you the author?
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.

Reference: Cancer. 2014 Jul 17. Epub ahead of print.
doi: 10.1002/cncr.28926

PubMed Abstract
PMID: 25042117 Prostate Cancer Section