Impact of Age and Life-expectancy on Treatment Receipt in High-risk Prostate Cancer
Kezhen Fei *
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Jenny J. Lin
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Stephen Supoyo
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Rebeca Franco
Grants Administration, New York University Langone Health, New York, NY 10023, USA.
Sarah Abramson
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Gerald Hoke
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
William Oh
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA and Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Richard Stock
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Nina A. Bickell
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
*Author to whom correspondence should be addressed.
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.