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Receipt of definitive therapy in elderly patients with unfavorable‐risk prostate cancer
Author(s) -
Yang David D.,
Mahal Brandon A.,
Muralidhar Vinayak,
Boldbaatar Ninjin,
Labe Shelby A.,
Nezolosky Michelle D.,
Vastola Marie E.,
Beard Clair J.,
Martin Neil E.,
Mouw Kent W.,
Orio Peter F.,
King Martin T.,
Nguyen Paul L.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30948
Subject(s) - medicine , androgen deprivation therapy , prostate cancer , radiation therapy , prostatectomy , comorbidity , cancer , logistic regression
BACKGROUND Conservative management of aggressive prostate cancer in the elderly without definitive therapy has been associated with a 10‐year prostate cancer‐specific mortality of approximately 50%. The authors examined the prevalence of definitive therapy in elderly patients with intermediate‐risk or high‐risk disease. METHODS 411,343 patients who were diagnosed from 2004 through 2012 with intermediate‐risk or high‐risk prostate cancer were identified in the National Cancer Database. Multivariable logistic regression adjusting for sociodemographic characteristics and comorbidity was used to examine the association between age and receipt of definitive therapy, defined as radical prostatectomy or radiotherapy, and of primary androgen deprivation therapy (ADT) among patients who did not receive definitive therapy. RESULTS In total, 87.1% of high‐risk patients and 91.9% of intermediate‐risk patients received definitive therapy. When stratified by age, 93.7%, 92.1%, 90.8%, 87.6%, 80.9%, and 55.2% of high‐risk patients and 96.1%, 94.7%, 93.4%, 89.7%, 82.7%, and 62.8% of intermediate‐risk patients ages <60, 60 to 64, 65 to 69, 70 to 74, 75 to 79, and ≥80 years received definitive therapy, respectively. For both high‐risk and intermediate‐risk patients, increasing age was significantly associated with a decreased likelihood of receiving definitive therapy overall (both P < .001) and a greater likelihood of receiving primary ADT among those who did not receive definitive therapy (both P < .001). CONCLUSIONS Older age was significantly associated with a decreased likelihood of receiving definitive therapy and an increased likelihood of receiving primary ADT in this national cohort of patients with intermediate‐risk or high‐risk prostate cancer. Notably, approximately 40% to 45% of patients aged ≥80 years did not receive definitive therapy. These findings are alarming given the dismal outcomes of conservatively managed unfavorable‐risk prostate cancer. Cancer 2017;123:4832‐40 . © 2017 American Cancer Society .