MP9-01 COMPARATIVE EFFECTIVENESS OF AGGRESSIVE VS NON-AGGRESSIVE TREATMENT FOR HIGH-GRADE PROSTATE CANCER ACROSS DIFFERENT COMORBIDITY LEVELS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-01 COMPARATIVE EFFECTIVENESS OF AGGRESSIVE VS NON-AGGRESSIVE TREATMENT FOR HIGH-GRADE PROSTATE CANCER ACROSS DIFFERENT COMORBIDITY LEVELS Timothy Daskivich, Julie Lai, Andrew Dick, Claude Setodji, Janet Hanley, Mark Litwin, and Christopher Saigal Timothy DaskivichTimothy Daskivich More articles by this author , Julie LaiJulie Lai More articles by this author , Andrew DickAndrew Dick More articles by this author , Claude SetodjiClaude Setodji More articles by this author , Janet HanleyJanet Hanley More articles by this author , Mark LitwinMark Litwin More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Older men with multiple comorbidities have high rates of death from causes other than prostate cancer within ten years of diagnosis, but they may benefit from aggressive therapy for high-grade disease. We sought to compare effectiveness of aggressive (surgery, radiation therapy, brachytherapy) vs. non-aggressive (watchful waiting, active surveillance) treatment in reducing cancer-specific mortality among older men with high-grade prostate cancer across differing levels of comorbidity. METHODS We sampled 44,521 men from the SEER-Medicare database, aged 66 and older, with clinically localized, poorly-differentiated prostate cancer diagnosed between 1991 and 2007. We used propensity-adjusted competing risks regression analysis to compare the risk of cancer-specific mortality between those treated aggressively and non-aggressively among comorbidity subgroups. We calculated 5-, 10-, and 15-year cancer mortality among those treated aggressively and non-aggressively for each comorbidity subgroup, determined 10-year absolute risk reduction in cancer mortality, and calculated the number needed to treat to save one life at ten years. Models were adjusted for age at diagnosis, race, stage, SEER region, socioeconomic status, marital status, and propensity for receiving aggressive treatment. RESULTS In propensity-adjusted competing risks regression analysis, aggressive treatment was associated with a significantly lower risk of cancer-specific mortality in men with high-grade tumors for those with Charlson scores of 0 (HR 0.43, 95% CI 0.39-0.47), 1 (HR 0.48, 95% CI 0.40-0.58), and 2 (HR 0.46, 95% CI 0.34-0.62) but not in men with Charlson scores of 3+ (HR 0.68, 95% CI 0.44-1.07). Absolute reduction in 10-year cancer specific mortality between those treated aggressively and non-aggressively was 11.3%, 7.9%, 8.6%, and 2.8% for men with Charlson scores of 0, 1, 2, and 3+, respectively. The numbers needed to treat to prevent one cancer death at ten years were 9, 13, 12, and 36 men for those with Charlson scores of 0, 1, 2, and 3+. CONCLUSIONS Older men with Charlson scores ≤2 should consider aggressive treatment of high-grade prostate cancer due to the substantial, short-term cancer-specific survival benefits of aggressive treatment and the relatively low number needed to treat to prevent one cancer death at ten years. Those with Charlson scores of 3 or greater may wish to pursue conservative management, given minimal benefit from aggressive treatment. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e102 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Daskivich More articles by this author Julie Lai More articles by this author Andrew Dick More articles by this author Claude Setodji More articles by this author Janet Hanley More articles by this author Mark Litwin More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...