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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 lifeexpectancy 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 intreatment decision-making.
ABSTRACT
ABSTRACT Social animals are faced with an intriguing dilemma. On the one hand, interactions between individuals are essential to exchange information and to promote cohesion, while on the other hand such interactions carry with them the risk of catching and transmitting parasites. This trade-off is particularly significant for social insects because low within-colony genetic diversity makes their colonies potentially vulnerable to parasites while frequent interactions are essential to the development of the colonial odor profile necessary for nestmate recognition. Here we investigate whether social interactions between young and old leaf-cutting ant workers show evidence of this trade-off. We find that old workers engage in more selfgrooming and mandibular scraping than young workers, both in keeping with old workers having been more exposed to parasites. In contrast, we find that young workers engaged in more allogrooming than old workers, which seems likely to have a different motivation possibly the transfer of recognition cues. Furthermore, young workers tended to engage in allogrooming with other young workers, although it was the old workers that were most active and with whom allogrooming would seem likely to optimize information or chemicals transfer. This suggests that young workers may be attempting to minimize the risk of parasite transmission during their social interactions. Although limited to behavioral data, these results hint that ant workers may be sensitive to the trade-off between the transmission of recognition cues and disease, and adjust their social interactions accordingly.