Timothy J Daskivich1, Julie Lai2, Andrew W Dick2, Claude M Setodji2, Janet M Hanley2, Mark S Litwin3, Christopher Saigal4. 1. Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Timothy.Daskivich@csmc.edu. 2. RAND Corporation, Santa Monica, CA. 3. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, CA. 4. RAND Corporation, Santa Monica, CA; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, CA.
Abstract
OBJECTIVE: To determine if the 10-year rule should apply to men with high-grade, clincially localized prostate cancer, we characterized the survival benefits of aggressive (surgery, radiation, brachytherapy) over nonaggressive treatment (watchful waiting, active surveillance) among older men with differing comorbidity at diagnosis. METHODS: We sampled 44,521 men older than 65 with cT1-2, poorly differentiated prostate cancer diagnosed in 1991-2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We used propensity-adjusted, competing-risks regression to calculate 5- and 10-year cancer mortality among those treated aggressively and nonaggressively across comorbidity subgroups. We determined 5- and 10-year absolute risk reduction in cancer mortality and numbers needed to treat to prevent one cancer death at 10 years. RESULTS: In propensity-adjusted, competing-risks regression analysis, aggressive treatment was associated with significantly lower risk of cancer mortality for those with Charlson scores of 0 (sub-hazard ratio (SHR) 0.43, 95% confidence interval [CI] 0.39-0.47), 1 (SHR 0.48, 95% CI 0.40-0.58), and 2 (SHR 0.46, 95% CI 0.34-0.62) but not 3+ (SHR 0.68, 95% CI 0.44-1.07). Absolute reductions in cancer mortality between those treated aggressively and nonaggressively were 7%, 5.5%, 6.9%, and 2.5% at 5 years, and 11.3%, 7.9%, 8.6%, and 2.8% at 10 years for men with Charlson scores of 0, 1, 2, and 3+ , respectively; numbers needed to treat to prevent 1 cancer death at 10 years were 9, 13, 12, and 36 men. CONCLUSION: The 10-year rule may not apply to men with high-grade, clinically localized disease. Older men with Charlson scores ≤2 should consider aggressive treatment of such disease due to its substantial short-term cancer survival benefits.
OBJECTIVE: To determine if the 10-year rule should apply to men with high-grade, clincially localized prostate cancer, we characterized the survival benefits of aggressive (surgery, radiation, brachytherapy) over nonaggressive treatment (watchful waiting, active surveillance) among older men with differing comorbidity at diagnosis. METHODS: We sampled 44,521 men older than 65 with cT1-2, poorly differentiated prostate cancer diagnosed in 1991-2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We used propensity-adjusted, competing-risks regression to calculate 5- and 10-year cancer mortality among those treated aggressively and nonaggressively across comorbidity subgroups. We determined 5- and 10-year absolute risk reduction in cancer mortality and numbers needed to treat to prevent one cancer death at 10 years. RESULTS: In propensity-adjusted, competing-risks regression analysis, aggressive treatment was associated with significantly lower risk of cancer mortality for those with Charlson scores of 0 (sub-hazard ratio (SHR) 0.43, 95% confidence interval [CI] 0.39-0.47), 1 (SHR 0.48, 95% CI 0.40-0.58), and 2 (SHR 0.46, 95% CI 0.34-0.62) but not 3+ (SHR 0.68, 95% CI 0.44-1.07). Absolute reductions in cancer mortality between those treated aggressively and nonaggressively were 7%, 5.5%, 6.9%, and 2.5% at 5 years, and 11.3%, 7.9%, 8.6%, and 2.8% at 10 years for men with Charlson scores of 0, 1, 2, and 3+ , respectively; numbers needed to treat to prevent 1 cancer death at 10 years were 9, 13, 12, and 36 men. CONCLUSION: The 10-year rule may not apply to men with high-grade, clinically localized disease. Older men with Charlson scores ≤2 should consider aggressive treatment of such disease due to its substantial short-term cancer survival benefits.
Authors: J B Eifler; J Alvarez; T Koyama; R M Conwill; C R Ritch; K E Hoffman; M J Resnick; D F Penson; D A Barocas Journal: J Urol Date: 2016-10-27 Impact factor: 7.450
Authors: Amar U Kishan; Ryan R Cook; Jay P Ciezki; Ashley E Ross; Mark M Pomerantz; Paul L Nguyen; Talha Shaikh; Phuoc T Tran; Kiri A Sandler; Richard G Stock; Gregory S Merrick; D Jeffrey Demanes; Daniel E Spratt; Eyad I Abu-Isa; Trude B Wedde; Wolfgang Lilleby; Daniel J Krauss; Grace K Shaw; Ridwan Alam; Chandana A Reddy; Andrew J Stephenson; Eric A Klein; Daniel Y Song; Jeffrey J Tosoian; John V Hegde; Sun Mi Yoo; Ryan Fiano; Anthony V D'Amico; Nicholas G Nickols; William J Aronson; Ahmad Sadeghi; Stephen Greco; Curtiland Deville; Todd McNutt; Theodore L DeWeese; Robert E Reiter; Johnathan W Said; Michael L Steinberg; Eric M Horwitz; Patrick A Kupelian; Christopher R King Journal: JAMA Date: 2018-03-06 Impact factor: 56.272
Authors: Kristina Vaculik; Michael Luu; Lauren E Howard; William Aronson; Martha Terris; Christopher Kane; Christopher Amling; Matthew Cooperberg; Stephen J Freedland; Timothy J Daskivich Journal: JAMA Netw Open Date: 2021-06-01