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

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


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.

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.
Original Research Article


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