Concerns about over-treatment have led to practice guidelines discouraging active treatment of prostate cancer (PCa) in men with limited life expectancies and/or low-risk tumors. We evaluated treatment patterns for older veterans with localized PCa, particularly those with low-risk features.
We used VA Cancer Registry data to identify men aged 65+ diagnosed with clinically localized PCa between January 1st, 2003 and December 31st, 2008 We obtained baseline data on demographics, tumor characteristics, comorbidities, and initial treatment within 6 months of diagnosis: radical prostatectomy, radiotherapy, primary androgen-deprivation therapy (PADT), or no active treatment National VA surveys provided facility data, including academic affiliation, availability of oncologic specialists, and distance to radiotherapy facilities Multinomial regression analyses determined associations between patient and facility characteristics and cancer treatment for men with localized (stage<III) and low-risk PCa (stage≤IIa, PSA<10ng/mL, Gleason ≤6)
17,206 veterans had localized PCa, 32% age 75+, 12% had comorbidity scores ≥3, and 33% had low-risk tumors Overall, 39% received radiotherapy, 6% surgery, 20% PADT, and 35% no active treatment For those with low-risk cancers, older men (RR=0 36, 95% CI 0 30-0 43) and sicker men (RR=0 75, 95% CI 0 62-0 90) were less likely to receive surgery or radiotherapy versus no active treatment Over time, more of these men received no active treatment (from 41% to 57%, P
VA treatment patterns followed evidence-based guidelines against treating older and sicker men with surgery or radiotherapy, for decreasing use of PADT, and for increasingly withholding active treatment, particularly for men with low-risk PCa
Cancer epidemiology 2015 Jul 27 [Epub ahead of print]
Richard M Hoffman, Ying Shi, Stephen J Freedland, Nancy L Keating, Louise C Walter
Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA Electronic address: richard-m-hoffman@uoiwa edu , San Francisco VA Medical Center, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA Electronic address: Ying Shi2@va gov , Urology Division, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA Electronic address: stephen freedland@cshs org , Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Electronic address: keating@hcp med harvard edu , San Francisco VA Medical Center, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA Electronic address: louise walter@ucsf edu