Objective:Recent studies have reported the underuse of active surveillance or watchful wait-ing for low-risk prostate cancer in the United States.This study examined prostate cancer-specific and all-cause death in eld...Objective:Recent studies have reported the underuse of active surveillance or watchful wait-ing for low-risk prostate cancer in the United States.This study examined prostate cancer-specific and all-cause death in elderly patients older than 75 years with low-risk tumors managed with active treatment versus watchful waiting with active surveillance(WWAS).Methods:We performed survival analysis in a cohort of 18,599 men with low-risk tumors(early and localized tumors)who were 75 years or older at the time of prostate cancer diagnosis in the linked Surveillance,Epidemiology,and End Results(SEER)-Medicare database(from 1992 to 1998)and who were followed up through December 2003.WWAS was defined as having an-nual screening for prostate-specific antigen and/or digital rectal examination during the follow-up period.The risks of prostate cancer-specific and all-cause death were compared by Cox regression models.The propensity score matching technique was used to address potential selection bias.Results:In patients with well-differentiated(Gleason score 2-4)and localized disease,those managed with WWAS without delayed treatment had higher risk of all-cause death(hazard ratio 1.20,95%confidence interval 1.13-1.28)but a substantially lower risk of prostate cancer-specific death(hazard ratio 0.62,confidence interval 0.51-0.75)than patients undergoing active treatment.Patients managed with WWAS with delayed treatment had comparable mortality outcomes.Sensi-tivity analyses based on propensity score matching yielded similar results.Conclusion:In men older than 75 years with well-differentiated and localized prostate cancer,WWAS without delayed treatment had a lower risk of prostate cancer-specific death and compa-rable all-cause death as compared with active treatment.Those patients in whom treatment was delayed had comparable mortality outcomes.Our results support WWAS as an initial management option for older men with well-differentiated and localized prostate cancer.展开更多
基金by grants from the National Cancer Institute(U54 CA-116867-01 to Li Li)the National Institute of Aging(P20 CA10373 to Li Li)Siran M.Koroukian was supported by a Career Development Grant from the National Cancer Institute(K07 CA096705).
文摘Objective:Recent studies have reported the underuse of active surveillance or watchful wait-ing for low-risk prostate cancer in the United States.This study examined prostate cancer-specific and all-cause death in elderly patients older than 75 years with low-risk tumors managed with active treatment versus watchful waiting with active surveillance(WWAS).Methods:We performed survival analysis in a cohort of 18,599 men with low-risk tumors(early and localized tumors)who were 75 years or older at the time of prostate cancer diagnosis in the linked Surveillance,Epidemiology,and End Results(SEER)-Medicare database(from 1992 to 1998)and who were followed up through December 2003.WWAS was defined as having an-nual screening for prostate-specific antigen and/or digital rectal examination during the follow-up period.The risks of prostate cancer-specific and all-cause death were compared by Cox regression models.The propensity score matching technique was used to address potential selection bias.Results:In patients with well-differentiated(Gleason score 2-4)and localized disease,those managed with WWAS without delayed treatment had higher risk of all-cause death(hazard ratio 1.20,95%confidence interval 1.13-1.28)but a substantially lower risk of prostate cancer-specific death(hazard ratio 0.62,confidence interval 0.51-0.75)than patients undergoing active treatment.Patients managed with WWAS with delayed treatment had comparable mortality outcomes.Sensi-tivity analyses based on propensity score matching yielded similar results.Conclusion:In men older than 75 years with well-differentiated and localized prostate cancer,WWAS without delayed treatment had a lower risk of prostate cancer-specific death and compa-rable all-cause death as compared with active treatment.Those patients in whom treatment was delayed had comparable mortality outcomes.Our results support WWAS as an initial management option for older men with well-differentiated and localized prostate cancer.
