Health outcomes in older men with localized prostate cancer: results from the Prostate Cancer Outcomes Study.
OBJECTIVE
We compared health-related quality-of-life (HRQOL) outcomes and survival of men with localized prostate cancer who received aggressive treatment with those receiving conservative management.


METHODS
We conducted a population-based cohort study of men aged 75 to 84 years when diagnosed with a clinically localized cancer in 1994 or 1995. We used medical record abstractions and patient surveys to obtain clinical and HRQOL data at diagnosis and 24-month follow-up. We used a propensity score method to adjust for baseline differences between men treated with radical prostatectomy or radiation therapy (n = 175) and men who received hormone therapy or no treatment (n = 290). Propensity scores were used in regression analyses comparing HRQOL outcomes between treatment groups. Overall and disease-specific survivals were estimated with multivariate proportional hazards models.


RESULTS
At 24 months following diagnosis, aggressively treated men were more likely to report daily urinary leakage (odds ratio [OR] = 2.9, 95% confidence interval [CI] 1.2-7.0) and to be bothered by urinary problems (OR = 5.1, 95% CI, 1.3-9.1) and sexual problems (OR = 2.8, 95% CI, 1.2-6.3). The adjusted disease-specific mortality hazard ratio was 0.43 (95% CI, 0.15, 1.28), favoring aggressive treatment. However, the absolute 5-year disease-specific survival difference was only 6% (98% vs 92%). Over 80% of all deaths were from other causes.


CONCLUSIONS
Aggressive treatment was associated with significant decreases in disease-specific HRQOL. However, men who were aggressively treated for localized cancer had a minimally reduced absolute risk of dying from prostate cancer. Physicians and older patients should consider these outcomes in making decisions about screening and treatment.
Hoffman
Richard M
RM
Medicine Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. rhoffman@unm.edu
Barry
Michael J
MJ
Stanford
Janet L
JL
Hamilton
Ann S
AS
Hunt
William C
WC
Collins
Mary McNaughton
MM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D006304:Health Status; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome