Life expectancy (LE) and the receipt of conservative versus active treatment in men with prostate cancer (CaP): A population-based study.

Abstract

6032 Background: Prostate-specific antigen (PSA) screening increases the diagnosis of low-risk and potentially clinically insignificant CaP, which raises concern for possible overtreatment. The National Comprehensive Cancer Network (NCCN) guidelines recommend surveillance (conservative management) for patients with less than 10 years LE diagnosed with low-risk cancer. In contrast, NCCN recommends active treatment for high-risk CaP, the most aggressive form of this disease, irrespective of LE. We examine patterns of care in CaP patients in the Surveillance, Epidemiology and End Results (SEER) registry by LE. Methods: 152,578 men with non-metastatic CaP diagnosed from 2004-8 were included. Gleason, PSA, and clinical stage were used for risk-categorization per D’Amico criteria. The sample was dichotomized into men 76 years and younger (who have an average LE of 10 years or more based on the US Social Security Administration actuarial period life tables) vs. 77 years and older (less than 10 years average LE). Logistic regression models examined factors associated with each treatment modality. Results: 56% of patients age 77 and older with low-risk CaP received conservative management, and 44% active treatment (Table). However, conservative management was just as common in older patients with high-risk cancer (62%); 21% of younger patients with high-risk CaP also received conservative management. Multivariable analysis showed decreased use of conservative management over time in older patients (OR 0.78 for 2008 vs. 2004, 95%CI 0.71-.86, p<.001). African American race, being unmarried, and older age were also significantly associated with conservative management. Conclusions: There may be overtreatment of low-risk CaP patients age 77 and older, which is worsening in recent years. Correspondingly, there appears to be undertreatment of elderly patients with high-risk CaP, the most aggressive form of this disease. [Table: see text]