title: Variation in treatment associated with life expectancy in a population-based cohort of men with early-stage prostate cancer.
abstract: BACKGROUND
  Men with major comorbidities are at risk for overtreatment of prostate cancer due to uncertainty regarding their life expectancy. We sought to characterize life expectancy and treatment in a population-based cohort of men with differing ages and comorbidity burdens at diagnosis.
  
  
  METHODS
  We sampled 96,032 men aged ≥66 years with early-stage prostate cancer who had Gleason scores ≤7 and were diagnosed during 1991 to 2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We calculated cumulative incidence of other-cause mortality and determined treatment patterns among subgroups defined by age and Charlson comorbidity index scores.
  
  
  RESULTS
  Overall, life expectancy was <10 years (10-year other-cause mortality rate, >50%) for 50,049 of 96,032 men (52%). Life expectancy differed by age and comorbidity score and was <10 years for men ages 66 to 69 years with Charlson scores ≥2, for men ages 70 to 74 years with Charlson scores ≥1, and for all men ages 75 to 79 years and ≥80 years. Among those who had a life expectancy <10 years, treatment was aggressive (surgery, radiation, or brachytherapy) for 68% of men aged 66 to 69 years, 69% of men aged 70 to 74 years, 57% of men aged 75 to 79 years, and 24% of men aged ≥80 years. Among these men, aggressive treatment was predominantly radiation therapy (50%, 53%, 63%, and 69%, respectively) and less frequently was surgery (30%, 25%, 13%, and 9%, respectively). Multivariate models revealed little variation in the probability of aggressive treatment by comorbidity status within age subgroups despite substantial differences in mortality.
  
  
  CONCLUSIONS
  Men aged <80 years at diagnosis who have life expectancies <10 years often receive aggressive treatment for low-risk and intermediate-risk prostate cancer, mostly with radiation therapy.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.forename: Claude M
authors.initials: CM
authors.lastname: Setodji
authors.forename: Janet M
authors.initials: JM
authors.lastname: Hanley
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Christopher
authors.initials: C
authors.lastname: Saigal
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D008017:Life Expectancy; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D018579:Patient Selection; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011878:Radiotherapy; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
keywords: comorbidity; life expectancy; outcomes; prostate adenocarcinoma; survival