BACKGROUND: Although elderly men, particularly patients with low-risk prostate cancer and a life expectancy less than 10 years, are unlikely to benefit from prostate cancer active therapy, treatment rates in this group are high. METHODS: By using the population-based Surveillance, Epidemiology, and End Results program linked to Medicare data from 2004 to 2005, we examined the effects of clinical and nonclinical factors on the selection of prostate cancer active therapy (ie, radical prostatectomy, external beam radiation therapy, brachytherapy, or androgen deprivation therapy) in men aged≥75 years with a new diagnosis of localized prostate cancer. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for receiving prostate cancer active therapy. RESULTS: The majority of men aged≥75 years were treated with prostate cancer active therapy (81.7%), which varied by disease risk level: low, 72.2%; intermediate, 83.7%; and high, 86.4%. Overall, in older men, the percentage of the total variance in the use of prostate cancer active therapy attributable to clinical and nonclinical factors was minimal, 5.1% and 2.6%, respectively. In men with low-risk disease, comorbidity status did not affect treatment selection, such that patients with 1 or 2+ comorbidities were as likely to receive prostate cancer active therapy as healthy men: OR=0.98; 95% CI, 0.76-1.27 and OR=1.19; 95% CI, 0.84-1.68, respectively. Geographic location was the most powerful predictor of treatment selection (Northeast vs Greater California: OR=2.41; 95% CI, 1.75-3.32). CONCLUSION: Clinical factors play a limited role in treatment selection among elderly patients with localized prostate cancer.
BACKGROUND: Although elderly men, particularly patients with low-risk prostate cancer and a life expectancy less than 10 years, are unlikely to benefit from prostate cancer active therapy, treatment rates in this group are high. METHODS: By using the population-based Surveillance, Epidemiology, and End Results program linked to Medicare data from 2004 to 2005, we examined the effects of clinical and nonclinical factors on the selection of prostate cancer active therapy (ie, radical prostatectomy, external beam radiation therapy, brachytherapy, or androgen deprivation therapy) in men aged≥75 years with a new diagnosis of localized prostate cancer. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for receiving prostate cancer active therapy. RESULTS: The majority of men aged≥75 years were treated with prostate cancer active therapy (81.7%), which varied by disease risk level: low, 72.2%; intermediate, 83.7%; and high, 86.4%. Overall, in older men, the percentage of the total variance in the use of prostate cancer active therapy attributable to clinical and nonclinical factors was minimal, 5.1% and 2.6%, respectively. In men with low-risk disease, comorbidity status did not affect treatment selection, such that patients with 1 or 2+ comorbidities were as likely to receive prostate cancer active therapy as healthy men: OR=0.98; 95% CI, 0.76-1.27 and OR=1.19; 95% CI, 0.84-1.68, respectively. Geographic location was the most powerful predictor of treatment selection (Northeast vs Greater California: OR=2.41; 95% CI, 1.75-3.32). CONCLUSION: Clinical factors play a limited role in treatment selection among elderly patients with localized prostate cancer.
Authors: Ian Thompson; James Brantley Thrasher; Gunnar Aus; Arthur L Burnett; Edith D Canby-Hagino; Michael S Cookson; Anthony V D'Amico; Roger R Dmochowski; David T Eton; Jeffrey D Forman; S Larry Goldenberg; Javier Hernandez; Celestia S Higano; Stephen R Kraus; Judd W Moul; Catherine M Tangen Journal: J Urol Date: 2007-06 Impact factor: 7.450
Authors: L C Harlan; A Potosky; F D Gilliland; R Hoffman; P C Albertsen; A S Hamilton; J W Eley; J L Stanford; R A Stephenson Journal: J Natl Cancer Inst Date: 2001-12-19 Impact factor: 13.506
Authors: Gerald L Andriole; E David Crawford; Robert L Grubb; Saundra S Buys; David Chia; Timothy R Church; Mona N Fouad; Edward P Gelmann; Paul A Kvale; Douglas J Reding; Joel L Weissfeld; Lance A Yokochi; Barbara O'Brien; Jonathan D Clapp; Joshua M Rathmell; Thomas L Riley; Richard B Hayes; Barnett S Kramer; Grant Izmirlian; Anthony B Miller; Paul F Pinsky; Philip C Prorok; John K Gohagan; Christine D Berg Journal: N Engl J Med Date: 2009-03-18 Impact factor: 91.245
Authors: Jan-Erik Johansson; Ove Andrén; Swen-Olof Andersson; Paul W Dickman; Lars Holmberg; Anders Magnuson; Hans-Olov Adami Journal: JAMA Date: 2004-06-09 Impact factor: 56.272
Authors: Richard M Hoffman; Stephen K Van Den Eeden; Kimberly M Davis; Tania Lobo; George Luta; Jun Shan; David Aaronson; David F Penson; Amethyst D Leimpeter; Kathryn L Taylor Journal: Psychooncology Date: 2017-07-13 Impact factor: 3.894
Authors: Karen E Hoffman; Jiangong Niu; Yu Shen; Jing Jiang; John W Davis; Jeri Kim; Deborah A Kuban; George H Perkins; Jay B Shah; Grace L Smith; Robert J Volk; Thomas A Buchholz; Sharon H Giordano; Benjamin D Smith Journal: JAMA Intern Med Date: 2014-09 Impact factor: 21.873
Authors: Paolo Dell'oglio; Anne Sophie Valiquette; Sami-Ramzi Leyh-Bannurah; Zhe Tian; Vincent Trudeau; Alessandro Larcher; Shahrokh F Shariat; Umberto Capitanio; Alberto Briganti; Markus Graefen; Francesco Montorsi; Pierre I Karakiewicz Journal: Can Urol Assoc J Date: 2018-03-19 Impact factor: 1.862
Authors: Richard M Hoffman; Tania Lobo; Stephen K Van Den Eeden; Kimberly M Davis; George Luta; Amethyst D Leimpeter; David Aaronson; David F Penson; Kathryn Taylor Journal: Med Decis Making Date: 2019-10-21 Impact factor: 2.583
Authors: G L Lu-Yao; S Kim; D F Moore; W Shih; Y Lin; R S DiPaola; S Shen; A Zietman; S-L Yao Journal: Prostate Cancer Prostatic Dis Date: 2015-06-23 Impact factor: 5.554
Authors: Timothy J Daskivich; Julie Lai; Andrew W Dick; Claude M Setodji; Janet M Hanley; Mark S Litwin; Christopher Saigal Journal: Cancer Date: 2014-07-17 Impact factor: 6.860
Authors: Richard M Hoffman; Ying Shi; Stephen J Freedland; Nancy L Keating; Louise C Walter Journal: Cancer Epidemiol Date: 2015-07-27 Impact factor: 2.984