Patterns of primary and secondary therapy for prostate cancer in elderly men: analysis of data from CaPSURE.

Abstract

We examined patterns of primary treatment for prostate cancer in men 75 years or older. Data were obtained from the multi-institutional CaPSURE database on the type of primary therapy performed in men younger than 75, or 75 years old or older. Primary therapy was defined as watchful waiting, radical prostatectomy, brachytherapy, brachytherapy plus external beam radiotherapy, external beam radiotherapy or primary androgen deprivation therapy. The chi-square test and multinomial logistic regression analysis were performed to identify predictors of the type of primary therapy and outcomes. A greater proportion of patients 75 years or older were white, single, had multiple comorbidities, low income and low education, and were classified as being at high risk compared to those younger than 75 years (43% vs 25%). On multivariate analysis adjusted for sociodemographic factors, diagnostic risk category and the number of comorbidities at diagnosis patients 75 years or older were less likely to be treated with primary therapy than with watchful waiting regardless of the risk category or comorbidity level. Older patients with high risk cancer are far more likely to be observed regardless of the burden of comorbidity. A more tailored approach to prostate cancer therapy that considers comorbidity and functional level to determine primary therapy may be more appropriate. Well selected older patients with high risk disease, particularly those with low comorbidity levels, may derive survival benefit from a primary therapy other than watchful waiting. Alternatively elderly patients with low risk disease may be better treated with watchful waiting.