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

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 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.MeasurementsOutcome 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.