PD12-05 DEFINING THE EXTENT AND NATURE OF OVERTREATMENT OF PROSTATE CANCER IN OLDER MEN

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2015PD12-05 DEFINING THE EXTENT AND NATURE OF OVERTREATMENT OF PROSTATE CANCER IN OLDER MEN Daniel Frendl, Jennifer Yates, Mara Epstein, Robert Blute, Mitchell Sokoloff, and John Ware Daniel FrendlDaniel Frendl More articles by this author , Jennifer YatesJennifer Yates More articles by this author , Mara EpsteinMara Epstein More articles by this author , Robert BluteRobert Blute More articles by this author , Mitchell SokoloffMitchell Sokoloff More articles by this author , and John WareJohn Ware More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1057AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Overtreatment of low- to moderate-risk prostate cancer (PCa) is of growing concern. The extent to which overtreatment occurs is debated, but some estimate rates at > 50%. Guidelines recommend that men likely to die of non-PCa causes within 10-years of diagnosis be conservatively managed. We explore 10-year non-PCa mortality rates following treatment, early mortality causes, and factors associated with treatment in a national Medicare managed care cohort. METHODS Using the linked Surveillance Epidemiology and End Results - Medicare Health Outcomes Survey database we identified 2,425 U.S. men, age <80, newly diagnosed with clinically localized (cT1a-cT3a) PCa from 1998–2009. Causes of non-PCa mortality were identified by ICD-10 codes. We compared non-PCa mortality rates across conservative management, radical prostatectomy (RP), and radiotherapy (brachytherapy or external-beam radiation) treated men. Cumulative incidence functions (CIF) for 10-year non-PCa mortality were plotted, accounting for the competing risk of dying from PCa. To assess factors associated with treatment assignment, for patients diagnosed 2004–2009, we used multinomial logistic regression to model primary treatment type by age, Charlson Comorbidity Index (CCI) score, patient-reported physical health, and smoking status, adjusting for D'Amico risk score, county-level RP rates, year of diagnosis, education, and race. RESULTS Overall, 13% of men underwent RP and 54% underwent radiotherapy. Over a median follow-up of 7.7 years, 19.2% of men died of non-PCa causes. CIF revealed 11%, 23%, and 32% 10-year non-PCa mortality rates among RP, radiotherapy, and conservatively managed patients, respectively. Among RP treated patients, other cancers (29%) and acute myocardial infarct (AMI) (18%) were leading causes of death. Among radiotherapy treated patients, frequent causes of non-PCa mortality were: other cancers (28%), ischemic heart disease (10%), AMI or heart failure (8%), and COPD (6%). While men of increasing age, CCI score, worse physical health, and smokers were less likely to undergo RP (p<0.05), only age was associated with reduced odds of radiotherapy, after adjusting for other factors. CONCLUSIONS Among older men with limited life expectancy rates of PCa overtreatment may be lower than previously reported but remain substantial. Research and policy efforts should target improving patient selection for radiotherapy, where 10-year non-PCa mortality rates remain higher and where identifiable comorbidities may aid in improving patient selection. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e257-e258 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Frendl More articles by this author Jennifer Yates More articles by this author Mara Epstein More articles by this author Robert Blute More articles by this author Mitchell Sokoloff More articles by this author John Ware More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...