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Receipt of definitive therapy in elderly patients with unfavorable-risk prostate cancer.

Abstract Conservative management of aggressive prostate cancer in the elderly without definitive therapy has been associated with a 10-year prostate cancer-specific mortality of approximately 50%. The authors examined the prevalence of definitive therapy in elderly patients with intermediate-risk or high-risk disease.
PMID
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Authors

Mayor MeshTerms
Keywords

androgen deprivation therapy

elderly

prostate cancer

radiation therapy

radical prostatectomy

Journal Title cancer
Publication Year Start




PMID- 28832984
OWN - NLM
STAT- Publisher
DA  - 20170823
LR  - 20170823
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Linking)
DP  - 2017 Aug 22
TI  - Receipt of definitive therapy in elderly patients with unfavorable-risk prostate 
      cancer.
LID - 10.1002/cncr.30948 [doi]
AB  - BACKGROUND: Conservative management of aggressive prostate cancer in the elderly 
      without definitive therapy has been associated with a 10-year prostate
      cancer-specific mortality of approximately 50%. The authors examined the
      prevalence of definitive therapy in elderly patients with intermediate-risk or
      high-risk disease. METHODS: 411,343 patients who were diagnosed from 2004 through
      2012 with intermediate-risk or high-risk prostate cancer were identified in the
      National Cancer Database. Multivariable logistic regression adjusting for
      sociodemographic characteristics and comorbidity was used to examine the
      association between age and receipt of definitive therapy, defined as radical
      prostatectomy or radiotherapy, and of primary androgen deprivation therapy (ADT) 
      among patients who did not receive definitive therapy. RESULTS: In total, 87.1%
      of high-risk patients and 91.9% of intermediate-risk patients received definitive
      therapy. When stratified by age, 93.7%, 92.1%, 90.8%, 87.6%, 80.9%, and 55.2% of 
      high-risk patients and 96.1%, 94.7%, 93.4%, 89.7%, 82.7%, and 62.8% of
      intermediate-risk patients ages <60, 60 to 64, 65 to 69, 70 to 74, 75 to 79, and 
      >/=80 years received definitive therapy, respectively. For both high-risk and
      intermediate-risk patients, increasing age was significantly associated with a
      decreased likelihood of receiving definitive therapy overall (both P < .001) and 
      a greater likelihood of receiving primary ADT among those who did not receive
      definitive therapy (both P < .001). CONCLUSIONS: Older age was significantly
      associated with a decreased likelihood of receiving definitive therapy and an
      increased likelihood of receiving primary ADT in this national cohort of patients
      with intermediate-risk or high-risk prostate cancer. Notably, approximately 40%
      to 45% of patients aged >/=80 years did not receive definitive therapy. These
      findings are alarming given the dismal outcomes of conservatively managed
      unfavorable-risk prostate cancer. Cancer 2017. (c) 2017 American Cancer Society.
CI  - (c) 2017 American Cancer Society.
FAU - Yang, David D
AU  - Yang DD
AUID- ORCID: http://orcid.org/0000-0002-5146-218X
AD  - Harvard Medical School, Boston, Massachusetts.
FAU - Mahal, Brandon A
AU  - Mahal BA
AD  - Harvard Radiation Oncology Program, Boston, Massachusetts.
FAU - Muralidhar, Vinayak
AU  - Muralidhar V
AD  - Harvard Radiation Oncology Program, Boston, Massachusetts.
FAU - Boldbaatar, Ninjin
AU  - Boldbaatar N
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Labe, Shelby A
AU  - Labe SA
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Nezolosky, Michelle D
AU  - Nezolosky MD
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Vastola, Marie E
AU  - Vastola ME
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Beard, Clair J
AU  - Beard CJ
AD  - Harvard Medical School, Boston, Massachusetts.
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Martin, Neil E
AU  - Martin NE
AD  - Harvard Medical School, Boston, Massachusetts.
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Mouw, Kent W
AU  - Mouw KW
AD  - Harvard Medical School, Boston, Massachusetts.
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Orio, Peter F 3rd
AU  - Orio PF 3rd
AD  - Harvard Medical School, Boston, Massachusetts.
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - King, Martin T
AU  - King MT
AD  - Harvard Medical School, Boston, Massachusetts.
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Nguyen, Paul L
AU  - Nguyen PL
AD  - Harvard Medical School, Boston, Massachusetts.
AD  - Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer
      Institute, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
DEP - 20170822
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
OTO - NOTNLM
OT  - androgen deprivation therapy
OT  - elderly
OT  - prostate cancer
OT  - radiation therapy
OT  - radical prostatectomy
EDAT- 2017/08/24 06:00
MHDA- 2017/08/24 06:00
CRDT- 2017/08/24 06:00
PHST- 2017/06/01 [received]
PHST- 2017/07/08 [revised]
PHST- 2017/07/17 [accepted]
AID - 10.1002/cncr.30948 [doi]
PST - aheadofprint
SO  - Cancer. 2017 Aug 22. doi: 10.1002/cncr.30948.