Fifteen-year outcomes following conservative management among men aged 65 years or older with localized prostate cancer

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

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Background To understand the threat posed by localized prostate cancer and the potential impact of surgery or radiation, patients and healthcare providers require information on long-term outcomes following conservative management. Objective To describe 15-yr survival outcomes and cancer therapy utilization among men 65 years and older managed conservatively for newly diagnosed localized prostate cancer. Design, settings, and participants This is a population-based cohort study with participants living in predefined geographic areas covered by the Surveillance, Epidemiology, and End Results program. The study includes 31 137 Medicare patients aged ≥65 yr diagnosed with localized prostate cancer in 1992-2009 who initially received conservative management (no surgery, radiotherapy, cryotherapy, or androgen deprivation therapy [ADT]). All patients were followed until death or December 31, 2009 (for prostate cancer-specific mortality [PCSM]) and December 31, 2011 (for overall mortality). Outcome measurements and statistical analysis Competing-risk analyses were used to examine PCSM, overall mortality, and utilization of cancer therapies. Results and limitations The 15-yr risk of PCSM for men aged 65-74 yr diagnosed with screening-detected prostate cancer was 5.7% (95% confidence interval [CI] 3.7-8.0%) for T1c Gleason 5-7 and 22% (95% CI 16-35%) for Gleason 8-10 disease. After 15 yr of follow-up, 24% (95% CI 21-27%) of men aged 65-74 yr with screening-detected Gleason 5-7 cancer received ADT. The corresponding result for men with Gleason 8-10 cancer was 38% (95% CI 32-44%). The major study limitations are the lack of data for men aged <65 yr and detailed clinical information associated with secondary cancer therapy. Conclusions The 15-yr outcomes following conservative management of newly diagnosed Gleason 5-7 prostate cancer among men aged ≥65 yr are excellent. Men with Gleason 8-10 disease managed conservatively face a significant risk of PCSM. Patient summary We examined the long-term survival outcomes for a large group of patients diagnosed with localized prostate cancer who did not have surgery, radiotherapy, cryotherapy, or androgen deprivation therapy in the first 6 mo after cancer diagnosis. We found that the 15-yr disease-specific survival is excellent for men diagnosed with Gleason 5-7 disease. The data support conservative management as a reasonable choice for elderly patients with low-grade localized prostate cancer.

Original languageEnglish
Pages (from-to)805-811
Number of pages7
JournalEuropean Urology
Volume68
Issue number5
DOIs
StatePublished - Nov 1 2015

Bibliographical note

Funding Information:
Funding/Support and role of the sponsor: This study was supported by the National Cancer Institute (grant R01 CA116399), the Center for Medicare and Medicaid Services, and Rutgers Cancer Institute of New Jersey (grant NCI CA-72720-10). The sponsors played a role in manuscript approval.

Publisher Copyright:
© 2015 European Association of Urology.

Keywords

  • Population-based study
  • Prostatic neoplasm
  • Survival

ASJC Scopus subject areas

  • Urology

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