MP73-19 PRIMARY ANDROGEN DEPRIVATION THERAPY INCREASES ALL CAUSE MORTALITY IN POPULATIONS MATCHED BY COMORBIDITY ADJUSTED LIFE EXPECTANCY AND DISEASE RISK

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced I1 Apr 2015MP73-19 PRIMARY ANDROGEN DEPRIVATION THERAPY INCREASES ALL CAUSE MORTALITY IN POPULATIONS MATCHED BY COMORBIDITY ADJUSTED LIFE EXPECTANCY AND DISEASE RISK Jesse Sammon, Firas Abdollah, Gally Reznor, Daniel Pucheril, Akshay Sood, Dane Klett, Julian Hanske, Christian Meyer, Mani Menon, and Quoc-Dien Trinh Jesse SammonJesse Sammon More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Gally ReznorGally Reznor More articles by this author , Daniel PucherilDaniel Pucheril More articles by this author , Akshay SoodAkshay Sood More articles by this author , Dane KlettDane Klett More articles by this author , Julian HanskeJulian Hanske More articles by this author , Christian MeyerChristian Meyer More articles by this author , Mani MenonMani Menon More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2695AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary androgen deprivation therapy (pADT) is commonly used to treat elderly men diagnosed with localized prostate cancer (CaP), despite being highly controversial and unsupported by any meaningful evidence or expert consensus guidelines. We examine the effect of pADT on mortality in elderly men with prostate cancer. To account for the effect of patient illness on life expectancy (LE) we incorporate calculations of comorbidity-adjusted LE (CaLE). METHODS We examine men residing in SEER registry areas, diagnosed with localized or locally advanced CaP between 1992-2009 and forgoing definitive therapy. Propensity score (PS) weighted Cox proportional hazards models were used to estimate the effect of pADT use on overall survival. Analysis was performed on the entire cohort and across comorbidity adjusted life expectancy (<5, 5-10 & >10 yr) and CaP risk sub-groups. We calculated the comorbidity-adjusted LE (CaLE) estimated with Cox proportional hazards modeling. Secondary analysis was performed on a contemporary population (2004-2009) to allow for incorporation of D'Amico risk stratification. RESULTS The study cohort included 46,376 men of which 17,873 received pADT (39%). Relative to observation, pADT was associated with a survival disadvantage, hazard ratio for all cause mortality 1.37 (95%CI: 1.20-1.56). In the 2004-2009 population the adverse affect of pADT was also demonstrated, HR 1.48 (95%CI: 1.12-1.95). The adverse effect of pADT was most pronounced in men with CaLE > 10 years (figure1). Results for the sub-population analysis are presented in table 1. CONCLUSIONS For men forgoing primary definitive therapy, the use of pADT is not associated with a survival benefit compared to observation, and denies men an opportunity for curative treatment. The deleterious effect of pADT is most pronounced in men with prolonged LE. Table 1. Adjusted risk of all cause mortality for men undergoing primary androgen deprivation therapy, relative to observation for localized and locally advanced prostate cancer, stratified by life expectancy and disease severity. SEER–Medicare 1992-2009 Standard Cox model Co-Morbidity Adjusted life expectancy Under 5 years 5-10 years Over 10 years HR (95%CI) p-value HR (95%CI) p-value HR (95%CI) p-value T1/T2 Low Risk* 0.95 (0.83-1.09) 0.5 1.11 (1.06-1.17) <0.001 1.39 (1.32-1.46) <0.001 T1/T2 High Risk* 0.91 (0.79-1.04) 0.16 1.17 (1.10-1.25) <0.001 1.51 (1.41-1.63) <0.001 T3 0.54 (0.3-0.98) 0.04 1.26 (1.06-1.51) 0.01 1.98 (1.74-2.27) <0.001 Propensity weighted Cox proportional hazards model+ Co-Morbidity Adjusted life expectancy Under 5 years 5-10 years Over 10 years HR (95%CI) p-value HR (95%CI) p-value HR (95%CI) p-value T1/T2 Low Risk* 0.96 (0.84-1.1) 0.6 1.1 (1.05-1.16) <0.001 1.36 (1.28-1.44) <0.001 T1/T2 High Risk* 0.85 (0.75-0.98) 0.02 1.11 (1.04-1.18) 0.001 1.46 (1.35-1.57) <0.001 T3 0.79 (0.49-1.29) 0.3 1.27 (0.94-1.35) 0.2 1.78 (1.56-2.04) <0.001 Abbreviations: HR, hazard ration; CI, confidence interval; pADT, primary androgen deprivation therapy +-Covariates included age at diagnosis, year at diagnosis, race, marital status, population density, census tract income and educational attainment, Charleson Comorbidity Index & pADT percent in patient’s HSA. *- Prior to 2003 Gleason grade of 2-4, 5-7, and 8-10 corresponded to well-differentiated (AJCC grade 1), moderately (AJCC grade 2) differentiated, and poorly differentiated disease (AJCC grade 3), respectively. Thereafter a Gleason grade of 2-4, 5-6, and 7-10 corresponded to well-differentiated, moderately differentiated, and poorly differentiated CaP. Well and moderately differentiated cancers constitute the low risk group. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e937-e938 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jesse Sammon More articles by this author Firas Abdollah More articles by this author Gally Reznor More articles by this author Daniel Pucheril More articles by this author Akshay Sood More articles by this author Dane Klett More articles by this author Julian Hanske More articles by this author Christian Meyer More articles by this author Mani Menon More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...