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Questioning the 10-year Life Expectancy Rule for High-grade Prostate Cancer: Comparative Effectiveness of Aggressive vs Nonaggressive Treatment of High-grade Disease in Older Men With Differing Comorbid Disease Burdens.
Daskivich, Timothy J; Lai, Julie; Dick, Andrew W; Setodji, Claude M; Hanley, Janet M; Litwin, Mark S; Saigal, Christopher.
Afiliación
  • Daskivich TJ; Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Timothy.Daskivich@csmc.edu.
  • Lai J; RAND Corporation, Santa Monica, CA.
  • Dick AW; RAND Corporation, Santa Monica, CA.
  • Setodji CM; RAND Corporation, Santa Monica, CA.
  • Hanley JM; RAND Corporation, Santa Monica, CA.
  • Litwin MS; 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.
  • Saigal C; 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.
Urology ; 93: 68-76, 2016 07.
Article en En | MEDLINE | ID: mdl-27079130
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Próstata / Esperanza de Vida Aspecto: Patient_preference Límite: Aged / Aged80 / Humans / Male Idioma: En Revista: Urology Año: 2016 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Próstata / Esperanza de Vida Aspecto: Patient_preference Límite: Aged / Aged80 / Humans / Male Idioma: En Revista: Urology Año: 2016 Tipo del documento: Article Pais de publicación: Estados Unidos