Variation in treatment associated with life expectancy in a population-based cohort of men with early-stage prostate cancer

Abstract

Background: Men with major comorbidities are at risk for overtreatment of prostate cancer due to uncertainty regarding their life expectancy. We sought to characterize life expectancy and treatment in a population-based cohort of men with differing ages and comorbidity burdens at diagnosis.

Methods: We sampled 96,032 men aged ≥66 years with early-stage prostate cancer who had Gleason scores ≤7 and were diagnosed during 1991 to 2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We calculated cumulative incidence of other-cause mortality and determined treatment patterns among subgroups defined by age and Charlson comorbidity index scores.

Results: Overall, life expectancy was <10 years (10-year other-cause mortality rate, >50%) for 50,049 of 96,032 men (52%). Life expectancy differed by age and comorbidity score and was <10 years for men ages 66 to 69 years with Charlson scores ≥2, for men ages 70 to 74 years with Charlson scores ≥1, and for all men ages 75 to 79 years and ≥80 years. Among those who had a life expectancy <10 years, treatment was aggressive (surgery, radiation, or brachytherapy) for 68% of men aged 66 to 69 years, 69% of men aged 70 to 74 years, 57% of men aged 75 to 79 years, and 24% of men aged ≥80 years. Among these men, aggressive treatment was predominantly radiation therapy (50%, 53%, 63%, and 69%, respectively) and less frequently was surgery (30%, 25%, 13%, and 9%, respectively). Multivariate models revealed little variation in the probability of aggressive treatment by comorbidity status within age subgroups despite substantial differences in mortality.

Conclusions: Men aged <80 years at diagnosis who have life expectancies <10 years often receive aggressive treatment for low-risk and intermediate-risk prostate cancer, mostly with radiation therapy.

Keywords: comorbidity; life expectancy; outcomes; prostate adenocarcinoma; survival.

Conflict of interest statement

Other authors have no conflicts of interest to report.

© 2014 American Cancer Society.

Figures

Figure 1. Cumulative Incidence of Other-Cause Mortality by Charlson Score at Ages (a) 66–69, (b) 70–74, (c) 75–79, and (d) 80+

Figure 2. a-d. Type of Treatment by Charlson Score at Ages (a) 66–69, (b) 70–74, (c) 75–79, and (d) 80+

Figure 3. Multivariate Predicted Probabilities of Aggressive Treatment by Age and Charlson Comorbidity Index Score Across Entire Cohort and Stratified by Year of Diagnosis

Footnote: Predicted probability estimates from a multivariate logistic regression model adjusted for tumor grade, tumor stage, race/ethnicity, martial status, SEER region, and year of diagnosis.