title: Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer.
abstract: BACKGROUND
  To understand the threat posed by localized prostate cancer and the potential impact of surgery or radiation, patients and healthcare providers require information on long-term outcomes following conservative management.
  
  
  OBJECTIVE
  To describe 15-yr survival outcomes and cancer therapy utilization among men 65 years and older managed conservatively for newly diagnosed localized prostate cancer.
  
  
  METHODS
  This is a population-based cohort study with participants living in predefined geographic areas covered by the Surveillance, Epidemiology, and End Results program. The study includes 31 137 Medicare patients aged ≥65 yr diagnosed with localized prostate cancer in 1992-2009 who initially received conservative management (no surgery, radiotherapy, cryotherapy, or androgen deprivation therapy [ADT]). All patients were followed until death or December 31, 2009 (for prostate cancer-specific mortality [PCSM]) and December 31, 2011 (for overall mortality).
  
  
  METHODS
  Competing-risk analyses were used to examine PCSM, overall mortality, and utilization of cancer therapies.
  
  
  CONCLUSIONS
  The 15-yr risk of PCSM for men aged 65-74 yr diagnosed with screening-detected prostate cancer was 5.7% (95% confidence interval [CI] 3.7-8.0%) for T1c Gleason 5-7 and 22% (95% CI 16-35%) for Gleason 8-10 disease. After 15 yr of follow-up, 24% (95% CI 21-27%) of men aged 65-74 yr with screening-detected Gleason 5-7 cancer received ADT. The corresponding result for men with Gleason 8-10 cancer was 38% (95% CI 32-44%). The major study limitations are the lack of data for men aged <65 yr and detailed clinical information associated with secondary cancer therapy.
  
  
  CONCLUSIONS
  The 15-yr outcomes following conservative management of newly diagnosed Gleason 5-7 prostate cancer among men aged ≥65 yr are excellent. Men with Gleason 8-10 disease managed conservatively face a significant risk of PCSM.
  
  
  RESULTS
  We examined the long-term survival outcomes for a large group of patients diagnosed with localized prostate cancer who did not have surgery, radiotherapy, cryotherapy, or androgen deprivation therapy in the first 6 mo after cancer diagnosis. We found that the 15-yr disease-specific survival is excellent for men diagnosed with Gleason 5-7 disease. The data support conservative management as a reasonable choice for elderly patients with low-grade localized prostate cancer.
authors: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA. Electronic address: luyaogr@cinj.rutgers.edu.
authors: Grace L
authors: GL
authors: Lu-Yao
authors: Department of Surgery (Urology), University of Connecticut, Farmington, CT, USA.
authors: Peter C
authors: PC
authors: Albertsen
authors: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA.
authors: Dirk F
authors: DF
authors: Moore
authors: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA.
authors: Yong
authors: Y
authors: Lin
authors: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
authors: Robert S
authors: RS
authors: DiPaola
authors: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
authors: Siu-Long
authors: SL
authors: Yao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019468:Disease Management; D006801:Humans; D008297:Male; D006278:Medicare; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D015996:Survival Rate; D014481:United States; D057832:Watchful Waiting
keywords: Population-based study; Prostatic neoplasm; Survival