title: Effectiveness of androgen-deprivation therapy and radiotherapy for older men with locally advanced prostate cancer.
abstract: OBJECTIVE
  We examined whether the survival advantage of androgen-deprivation therapy with radiotherapy (ADT plus RT) relative to ADT alone for men with locally advanced prostate cancer reported in two randomized trials holds in real-world clinical practice and extended the evidence to patients poorly represented in the trials.
  
  
  METHODS
  We conducted nonrandomized effectiveness studies of ADT plus RT versus ADT in three groups of patients diagnosed between 1995 and 2007 and observed through 2009 in the SEER-Medicare data set: (1) the randomized clinical trial (RCT) cohort, which included men age 65 to 75 years and was most consistent with participants in the randomized trials; (2) the elderly cohort, which included men age > 75 years with locally advanced prostate cancer; and (3) the screen-detected cohort, which included men age ≥ 65 years with screen-detected high-risk prostate cancer. We evaluated cause-specific and all-cause mortality using propensity score, instrumental variable (IV), and sensitivity analyses.
  
  
  RESULTS
  In the RCT cohort, ADT plus RT was associated with reduced cause-specific and all-cause mortality relative to ADT alone (cause-specific propensity score-adjusted hazard ratio [HR], 0.43; 95% CI, 0.37 to 0.49; all-cause propensity score-adjusted HR, 0.63; 95% CI, 0.59 to 0.67). Effectiveness estimates for the RCT cohort were not significantly different from those from randomized trials (P > .1). In the elderly and screen-detected cohorts, ADT plus RT was also associated with reduced cause-specific and all-cause mortality. IV analyses produced estimates similar to those from propensity score-adjusted methods.
  
  
  CONCLUSIONS
  Older men with locally advanced or screen-detected high-risk prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival.
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA. bekelman@uphs.upenn.edu.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Handorf
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Hahn
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.affiliation: Justin E. Bekelman, Nandita Mitra, Stephen A. Hahn, and Daniel Polsky, University of Pennsylvania; Elizabeth A. Handorf and Robert G. Uzzo, Fox Chase Cancer Center, Philadelphia, PA; and Katrina Armstrong, Massachusetts General Hospital, Boston, MA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D006278:Medicare; D060787:Neoplasm Grading; D057216:Propensity Score; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal