Primary Treatment Choice Over Time and Relative Survival of Prostate Cancer Patients: Influence of Age, Grade, and Stage

Abstract

Background: The aim of this study was to assess associations of stage, grade, and age with the primary treatment of prostate cancer (PCa) patients comparing the incidence years 2000/2001 and 2012/2013, and to estimate the relative survival (RS) for patients diagnosed in 2000/2001. Methods: We included 1,541 men diagnosed in 2000/2001 and 1,605 men diagnosed in 2012/2013. Multiple imputation methods were applied to missing data for stage and grade. Multinomial logistic regression analyses were used to explore the associations of stage, grade, and age with treatment. RS was estimated using the Ederer II approach. Results: In 2000/2001, older patients were more likely to choose active surveillance (AS)/watchful waiting (WW) or to receive androgen deprivation therapy (ADT) compared to surgery; in 2012/2013, this association was only observed for ADT but not for AS/WW. In 2000/2001, the overall 1-, 5-, and 10-year RS was approximately 99, 94, and 92%, respectively. RS was highest for patients who underwent surgical procedures or radiotherapy and considerably lower for patients with ADT. Conclusion: Our data show that today AS/WW is an option not only for patients with a life expectancy of < 10 years but also for younger men with localized PCa. PCa patients have a good RS if the cancer is diagnosed at an early stage.