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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.

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.

journal_name

Urology

journal_title

Urology

authors

Daskivich TJ,Lai J,Dick AW,Setodji CM,Hanley JM,Litwin MS,Saigal C,Urologic Disease in America Project.

doi

10.1016/j.urology.2016.02.057

subject

Has Abstract

pub_date

2016-07-01 00:00:00

pages

68-76

eissn

0090-4295

issn

1527-9995

pii

S0090-4295(16)30064-4

journal_volume

pub_type

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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.