Do older men benefit from curative therapy of localized prostate cancer?

被引:136
作者
Alibhai, SMH
Naglie, G
Nam, R
Trachtenberg, J
Krohn, MD
机构
[1] Univ Hlth Network, Div Gen Internal Med & Clin Epidemiol, Toronto, ON M5G 2C4, Canada
[2] Toronto Rehabil Inst, Geriatr Program, Toronto, ON, Canada
[3] Univ Toronto, Dept Med, Toronto, ON, Canada
[4] Univ Toronto, Dept Hlth Policy, Toronto, ON, Canada
[5] Univ Toronto, Dept Management & Evaluat, Toronto, ON, Canada
[6] Univ Toronto, Dept Surg, Toronto, ON, Canada
关键词
D O I
10.1200/JCO.2003.09.034
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose : Prior decision-analytic models are based on outdated or suboptimal efficacy, patient preference, and comorbidity data. We estimated life expectancy (LE) and quality-adjusted life expectancy (OALE) associated with available treatments for localized prostate cancer in men aged greater than or equal to 65 years, adjusting for Gleason score, patient preferences, and comorbidity. Methods: We evaluated three treatments, using a decision-analytic Markov model: radical prostatectomy (RP), external beam radiotherapy (EBRT), and watchful waiting (WW). Rates of treatment complications and pretreatment incontinence and impotence were derived from published studies. We estimated treatment efficacy using three data sources: cancer registry cohort data, pooled case series, and modern radiotherapy studies. Utilities were obtained from 141 prostate cancer patients and from published studies. Results: For men with well-differentiated tumors and few comorbidities, potentially curative therapy (RP or EBRT) prolonged LE up to age 75 years but did not improve OALE at any age. For moderately differentiated cancers, potentially curative therapy resulted in LE and OALE gains up to age 75 years. For poorly differentiated disease, potentially curative therapy resulted in LE and OALE gains up to age 80 years. Benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity. When cohort and pooled case series data were used, RP was preferred over EBRT in all groups but was comparable to modern radiotherapy. Conclusion: Potentially curative therapy results in significantly improved LE and OALE for older men with few comorbidities and moderately or poorly differentiated localized prostate cancer. Age should not be a barrier to treatment in this group. (C) 2003 by American Society of Clinical Oncology.
引用
收藏
页码:3318 / 3327
页数:10
相关论文
共 104 条
[1]   Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer [J].
Albertsen, PC ;
Hanley, JA ;
Gleason, DF ;
Barry, MJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (11) :975-980
[2]   The impact of co-morbidity on life expectancy among men with localized prostate cancer [J].
Albertsen, PC ;
Fryback, DG ;
Storer, BE ;
Kolon, TF ;
Fine, J .
JOURNAL OF UROLOGY, 1996, 156 (01) :127-132
[3]   LONG-TERM SURVIVAL AMONG MEN WITH CONSERVATIVELY TREATED LOCALIZED PROSTATE-CANCER [J].
ALBERTSEN, PC ;
FRYBACK, DG ;
STORER, BE ;
KOLON, TF ;
FINE, J .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (08) :626-631
[4]  
ALIBHAI SMH, 2000, CLIN INVEST MED, V23, P332
[5]   DEFINITIVE RADIATION-THERAPY FOR LOCALIZED PROSTATIC ADENOCARCINOMA [J].
ARCANGELI, G ;
MICHELI, A ;
ARCANGELI, G ;
PANSADORO, V ;
DEPAULA, F ;
GIANNARELLI, D ;
BENASSI, M .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1991, 20 (03) :439-446
[6]   EAU guidelines on prostate cancer [J].
Aus, G ;
Abbou, CC ;
Pacik, D ;
Schmid, HP ;
van Poppel, H ;
Wolff, JM ;
Zattoni, F .
EUROPEAN UROLOGY, 2001, 40 (02) :97-101
[7]  
Aygun C, 1995, Md Med J, V44, P363
[8]   HOW USEFUL ARE MODELS OF NATURAL-HISTORY IN CLINICAL DECISION-MAKING AND CLINICAL RESEARCH [J].
BECK, JR ;
SCARDINO, PT .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1994, 47 (01) :1-2
[9]  
Bennett CL, 1997, EUR UROL, V32, P86
[10]  
BENNETT CL, 1991, CANCER, V67, P2633, DOI 10.1002/1097-0142(19910515)67:10<2633::AID-CNCR2820671039>3.0.CO