Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?

Grace L. Lu-Yao; Peter C. Albertsen; Hui Li; Dirk F. Moore; Weichung Shih; Yong Lin; Robert S. Dipaola; Siu Long Yao

doi:10.1016/j.eururo.2012.05.003

Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?

Grace L. Lu-Yao, Peter C. Albertsen, Hui Li, Dirk F. Moore, Weichung Shih, Yong Lin, Robert S. Dipaola, Siu Long Yao

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background: Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective: This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants: This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis: Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations: This study includes 29 775 men who did not receive local therapy for T1-T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2-7 in 1992-2002 and Gleason score 2-6 in 2003-2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08-1.44) and a borderline higher use of any palliative cancer treatment (HR: 1.07; 95% CI, 0.97-1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions: Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.

Original language	English
Pages (from-to)	966-972
Number of pages	7
Journal	European Urology
Volume	62
Issue number	6
DOIs	https://doi.org/10.1016/j.eururo.2012.05.003
State	Published - Dec 2012

Bibliographical note

Funding Information:
Financial disclosures: Grace L. Lu-Yao certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Grace Lu-Yao has received clinical research funding from the New Jersey Commission on Cancer Research. Dr. Peter Albertson has received clinical research funding from Sanofi-Aventis and consultation fees from Blue Cross/Blue Shield. Dr. Weichung Shih has received clinical research funding from Myriad; Dr. Dirk Moore has received funding from Innocentive Inc., and the National Cancer Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Siu-Long Yao has been employed by Schering-Plough and Merck Research Laboratory in the area of clinical cancer research. None of these entities contributed funding, or played any role whatsoever in the design, interpretation, or drafting of our study or manuscript.

Funding Information:
Funding/Support and role of the sponsor: This study was supported in part by award number DAMD17–01–1-0755 from the US Army Medical Research Acquisition Activity, Fort Detrick, MD, USA, and by the Cancer Institute of New Jersey, DOD award W81XWG-05–1-0235, and by National Cancer Institute (NCI) grant R01 CA116399 and CINJ core grant NCI CA-72720–10. NCI provided funding for this study but did not play any role in the design and conduct of the study, analysis and interpretation of the data, or preparation of the manuscript. The study received institutional review board approval from the University of Medicine and Dentistry of New Jersey as well as the Surveillance Epidemiology and End Results (SEER) program and the Center for Medicare and Medicaid Services (CMS). The performance and design of this study were reviewed and approved by both NCI and CMS. This study uses the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The content of the information does not necessarily reflect the position or the policy of the government, and no official endorsement should be inferred.

Keywords

Antineoplastic agents-hormonal
Medicare
Prostatic neoplasm
SEER program

ASJC Scopus subject areas

Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.eururo.2012.05.003

Cite this

@article{be8172fcf9b542f49662741b716a7699,

title = "Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?",

abstract = "Background: Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective: This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants: This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis: Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations: This study includes 29 775 men who did not receive local therapy for T1-T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2-7 in 1992-2002 and Gleason score 2-6 in 2003-2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08-1.44) and a borderline higher use of any palliative cancer treatment (HR: 1.07; 95% CI, 0.97-1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions: Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.",

keywords = "Antineoplastic agents-hormonal, Medicare, Prostatic neoplasm, SEER program",

author = "Lu-Yao, {Grace L.} and Albertsen, {Peter C.} and Hui Li and Moore, {Dirk F.} and Weichung Shih and Yong Lin and Dipaola, {Robert S.} and Yao, {Siu Long}",

note = "Funding Information: Financial disclosures: Grace L. Lu-Yao certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Grace Lu-Yao has received clinical research funding from the New Jersey Commission on Cancer Research. Dr. Peter Albertson has received clinical research funding from Sanofi-Aventis and consultation fees from Blue Cross/Blue Shield. Dr. Weichung Shih has received clinical research funding from Myriad; Dr. Dirk Moore has received funding from Innocentive Inc., and the National Cancer Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Siu-Long Yao has been employed by Schering-Plough and Merck Research Laboratory in the area of clinical cancer research. None of these entities contributed funding, or played any role whatsoever in the design, interpretation, or drafting of our study or manuscript. Funding Information: Funding/Support and role of the sponsor: This study was supported in part by award number DAMD17–01–1-0755 from the US Army Medical Research Acquisition Activity, Fort Detrick, MD, USA, and by the Cancer Institute of New Jersey, DOD award W81XWG-05–1-0235, and by National Cancer Institute (NCI) grant R01 CA116399 and CINJ core grant NCI CA-72720–10. NCI provided funding for this study but did not play any role in the design and conduct of the study, analysis and interpretation of the data, or preparation of the manuscript. The study received institutional review board approval from the University of Medicine and Dentistry of New Jersey as well as the Surveillance Epidemiology and End Results (SEER) program and the Center for Medicare and Medicaid Services (CMS). The performance and design of this study were reviewed and approved by both NCI and CMS. This study uses the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The content of the information does not necessarily reflect the position or the policy of the government, and no official endorsement should be inferred. ",

year = "2012",

month = dec,

doi = "10.1016/j.eururo.2012.05.003",

language = "English",

volume = "62",