ASPO Abstracts
Prostate Cancer Treatment and Survival in Pennsylvania: The Influence of Age at Diagnosis
Category: Early Detection & Risk Prediction, Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2018
Abstract Body:
Purpose: To assess age-related cancer treatment patterns in Pennsylvania prostate cancer survivors and the potential impact on survival. Methods: We used Pennsylvania Cancer Registry data to identify men 40 years with a clinical diagnosis of prostate cancer (Gleason Score 6) between 2004-2014. We compared, demographic and clinical descriptors (including race/ethnicity, rurality, disease aggressiveness) by age <65 (“younger”) v. 65 years (“older”). Prostate cancer aggressiveness was based on Gleason Score (GS) and tumor stage (less aggressive=GS 6-7 and T1-T2; more aggressive=GS 7-10 or T3-T4). Treatment was categorized as local only (radiation and/or surgery) v. systemic (local plus hormonal therapy and/or chemotherapy) treatment. Logistic and Cox regression were used to assess the association of covariates with treatment and prostate-cancer death. Results: Our sample (n=94,262) included survivors ages 40-105 years (mean=66 yrs, SD=0.4). The majority were white (83%) or Black (10%) from urban settings (69%). Most older survivors had aggressive disease (62%) compared to younger survivors (37%). More older survivors (28%) received hormonal therapy than younger survivors (12%), but more (62%) younger survivors received surgery than older survivors (28%). Older survivors were 3 times more likely to receive systemic v. local treatment compared to younger survivors (OR=2.78, p<.001;95% CI 2.6-3), controlling for disease aggressiveness and other covariates. Older men that received systemic treatment had a 28% risk reduction for cancer death compared to younger men that received systemic treatment (HR=0.72, p<0.001;95% CI 0.60-0.87). For local treatment, the hazards of cancer death were 2.5 times greater for older men than younger men (HR=2.47, p<.001;95% CI 1.94-3.15). Conclusion: Older survivors were more likely to receive systemic treatment and had better survival than younger men with similar treatment. But, older men that received local treatment only had increased risk of cancer death compared to younger men with local treatment. Given lack of consensus on prostate cancer treatment guidelines and problematic treatment side effects, older survivors may need special consideration in survivorship care. Lifestyle interventions may reduce symptoms and recurrence.
Keywords: Prostate cancer, older survivors, treatment