Publication Abstract

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

Title: Questioning the Ten-Year Life Expectancy Rule for High-Grade Prostate Cancer: Comparative Effectiveness of Aggressive Vs. Non-Aggressive Treatment of High-Grade Disease in Older Men with Differing Comorbid Disease Burdens.

Journal: Urology :-

Date: 2016 Apr 11

Abstract: OBJECTIVE: To determine if the ten-year rule should apply to men with high-grade, clincially localized prostate cancer, we characterized the survival benefits of aggressive (surgery, radiation, brachytherapy) over non-aggressive 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 SEER-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 ten 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 (SHR0.43, 95%CI 0.39-0.47), 1 (SHR0.48, 95%CI 0.40-0.58), and 2 (SHR0.46, 95%CI 0.34-0.62) but not 3+ (SHR0.68, 95%CI 0.44-1.07). Absolute reductions in cancer mortality between those treated aggressively and non-aggressively 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 one cancer death at ten years were 9, 13, 12, and 36 men. CONCLUSIONS: The ten-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.