938 PATTERNS OF CARE IN THE USE OF PALLIATIVE THERAPY FOR URETERAL OBSTRUCTION AMONG ELDERLY PATIENTS WITH ADVANCED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced III1 Apr 2012938 PATTERNS OF CARE IN THE USE OF PALLIATIVE THERAPY FOR URETERAL OBSTRUCTION AMONG ELDERLY PATIENTS WITH ADVANCED PROSTATE CANCER Benjamin Spencer, Beverly Insel, Dawn Hershman, Mitchell Benson, and Alfred Neugut Benjamin SpencerBenjamin Spencer New York, NY More articles by this author , Beverly InselBeverly Insel New York, NY More articles by this author , Dawn HershmanDawn Hershman New York, NY More articles by this author , Mitchell BensonMitchell Benson New York, NY More articles by this author , and Alfred NeugutAlfred Neugut New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1036AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral obstruction is a complication of advanced prostate cancer which can be relieved with placement of either retrograde ureteral stent (RUS) or percutaneous nephrostomy (PCN) to palliate symptoms associated with obstructive uropathy. We investigated predictors of ureteral obstruction, its treatment, and its influence on survival, for older patients with advanced prostate cancer. METHODS Using the SEER-Medicare database, we identified patients age 65 or older with stage IV (n=10,848) or recurrent (n=7,872) prostate cancer. We used logistic regression to compare those with and without ureteral obstruction, and among the obstructed, those treated with RUS or PCN to those not so treated, adjusting for demographic, clinical, and physician factors. Cox proportional-hazards regression was used to analyze the association between RUS, PCN and overall survival. RESULTS Ureteral obstruction developed in 16% (n=2,958) of the sample. As compared to no treatment, African-Americans were more likely to undergo placement of a PCN (OR 1.48, 95% CI 1.03, 2.13) than whites. Octogenarians were less likely to undergo RUS (ages 80-84: OR 0.41, 95% C.I. 0.27, 0.63, ages 85 and greater: O.R. 0.30, 95% C.I. 0.16, 0.54) as compared to patients 65-69 years old. Subjects treated by more recently-graduated physicians were more likely to receive both RUS (1986-2003: OR 2.60, 95% C.I. 2.05, 3.29) and PCN (1986-2003: OR 3.60, 95% C.I. 2.80, 4.62) than earlier graduates. Subjects receiving PCN were 55% more likely to die (OR 1.55, 95% CI 1.37, 1.75) than the untreated. Nine percent of subjects received their first RUS or PCN within 30 days of dying. There was no difference in survival among those receiving RUS compared to the untreated. CONCLUSIONS This is the first large, population-based study to demonstrate a racial disparity in the palliative treatment of advanced prostate cancer. Since these therapies provide no survival benefit and are usually initiated during the final year of life, patients should be carefully selected and apprised of the goals of palliative therapy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e382 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Spencer New York, NY More articles by this author Beverly Insel New York, NY More articles by this author Dawn Hershman New York, NY More articles by this author Mitchell Benson New York, NY More articles by this author Alfred Neugut New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...