Impact of Age and Life-expectancy on Treatment Receipt in High-risk Prostate Cancer

Main Article Content

Kezhen Fei
Jenny J. Lin
Stephen Supoyo
Rebeca Franco
Sarah Abramson
Gerald Hoke
William Oh
Richard Stock
Nina A. Bickell

Abstract

Background/Objectives:  The incidence of Prostate cancer is increasing with age and active treatment of high-risk prostate cancer improves survival. However, it is uncertain how the age as contrasted with life expectancy impact treatment decision-making for men with clinically significant prostate cancer. The aim of this study was to determine whether age or life expectancy affected the treatment receipt.

Participants: 541 men with high-risk localized prostate cancer (Gleason ≥ 8 or PSA > 20) diagnosed between 2007 and 2013 were recruited to the study.

Measurements: Outcome variables included treatment underuse and type of definitive therapies such as radical prostatectomy, radiotherapy, androgen deprivation therapy and cryotherapy. Life expectancy was assessed according to Schonberg Prognostic Index.

Results: Among the 541 high-risk prostate cancer patients, older men (≥65 years) received definitive therapy at similar rates as younger men (97% vs 98%; p=0.2), while younger men were more likely to accept surgery compared with older men (95% vs. 72%, p<0.001). Age affected treatment choice depending on the patient's life expectancy. Among men with higher life expectancy, age did not affect surgery receipt (OR=0.62; 95%CI: 0.18-2.20). But among men with lower life expectancy, older age (OR=0.15; 95%CI: 0.06-0.38), black race (OR=0.27; 95%CI: 0.10-0.77), comorbidity (OR=0.31; 95%CI: 0.13-0.76) and non-commercial insurance (OR=0.12, 95%CI: 0.05-0.28) were associated with lower rate of surgical receipt.

Conclusion: Although most high-risk prostate cancer patients undergo definitive therapy, both age and life expectancy affected the type of treatment. Clinical decisions appear to be based on patients’ medical condition and long-term outlook, rather than simply age. Non-clinical factors such as race and insurance play a role in treatment decision-making.

Keywords:
Prostate cancer, radical prostatectomy, radiotherapy, cryotherapy, life expectancy.

Article Details

How to Cite
Fei, K., Lin, J. J., Supoyo, S., Franco, R., Abramson, S., Hoke, G., Oh, W., Stock, R., & Bickell, N. A. (2019). Impact of Age and Life-expectancy on Treatment Receipt in High-risk Prostate Cancer. Journal of Advances in Medicine and Medical Research, 30(11), 1-9. https://doi.org/10.9734/jammr/2019/v30i1130248
Section
Original Research Article

References

Richstone L, Bianco FJ, Shah HH, et al. Radical prostatectomy in men aged >or=70 years: effect of age on upgrading, upstaging, and the accuracy of a preoperative nomogram. BJU Int. 2008; 101:541-6.

Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367:203-13.

Bratt O, Folkvaljon Y, Hjalm Eriksson M, et al. Undertreatment of men in their seventies with high-risk non metastatic prostate Cancer. Eur Urol. 2015;68:53-8.

Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA: A Cancer Journal for Clinicians. 2004;54:78-93.

Zeliadt SB, Potosky AL, Etzioni R, Ramsey SD, Penson DF. Racial disparity in primary and adjuvant treatment for nonmetastatic prostate cancer: SEER-Medicare trends 1991 to 1999. Urology. 2004;64:1171-6.

Bechis SK, Carroll PR, Cooperberg MR. Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol. 2011;29:235-41.

Berg S, Cole AP, Krimphove MJ, et al. Comparative effectiveness of radical prostatectomy versus external beam radiation therapy plus brachytherapy in patients with high-risk localized prostate Cancer. Eur Urol. 2019;75:552-5.

Boorjian SA, Karnes RJ, Viterbo R, et al. Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. Cancer. 2011;117:2883-91.

Ennis RD, Hu L, Ryemon SN, Lin J, Mazumdar M. Brachytherapy-based radiotherapy and radical prostatectomy are associated with similar survival in high-risk localized prostate Cancer. J Clin Oncol. 2018;36:1192-8.

Hurria A, Levit LA, Dale W, et al. Improving the evidence base for treating older adults with Cancer: American society of clinical oncology statement. J Clin Oncol. 2015;33: 3826-33.

Droz JP, Balducci L, Bolla M, et al. Management of prostate cancer in older men: recommendations of a working group of the International Society of Geriatric Oncology. BJU Int. 2010;106: 462-9.

Wong YN, Mitra N, Hudes G, et al. Survival associated with treatment vs observation of localized prostate cancer in elderly men. JAMA. 2006;296: 2683-93.

Walker DM, Mc Alearney AS, Sova LN, Lin JJ, Abramson S, Bickell NA. Comparing prostate cancer treatment decision making in a resource-rich and a resource-poor environment: A tale of two hospitals. J Natl Med Assoc. 2016;108:211-9.

Bickell NA, Lin JJ, Abramson SR, et al. Racial disparities in clinically significant prostate cancer treatment: The potential health information technology offers. J Oncol Pract. 2018;14:e23-e33.

D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969-74.

Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older. J Am Geriatr Soc. 2011;59:1444-51.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373- 83.

Widmark A, Klepp O, Solberg A, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009; 373:301-8.

Mohler JL, Armstrong AJ, Bahnson RR, et al. Prostate cancer, Version 3.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012;10:1081-7.

Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65:124-37.

Chen RC, Carpenter WR, Hendrix LH, et al. Receipt of guideline-concordant treatment in elderly prostate cancer patients. Int J Radiat Oncol Biol Phys. 2014;88:332-8.

Shumway DA, Hamstra DA. Ageism in the undertreatment of high-risk prostate cancer: how long will clinical practice patterns resist the weight of evidence? J Clin Oncol. 2015;33:676-8.

Xu J, Neale AV, Dailey RK, Eggly S, Schwartz KL. Patient perspective on watchful waiting/active surveillance for localized prostate cancer. J Am Board Fam Med. 2012;25:763-70.

Hajjaj FM, Salek MS, Basra MK, Finlay AY. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice. J R Soc Med. 2010;103:178-87.

Yang DD, Mahal BA, Muralidhar V, et al. Receipt of definitive therapy in elderly patients with unfavorable-risk prostate cancer. Cancer. 2017;123:4832-40.

Gill TM. The central role of prognosis in clinical decision making. JAMA. 2012;307: 199-200.

Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: A systematic review. JAMA. 2012;307:182-92.

Eckstrom E, Feeny DH, Walter LC, Perdue LA, Whitlock EP. Individualizing cancer screening in older adults: A narrative review and framework for future research. J Gen Intern Med. 2013;28:292-8.