Health Outcomes in Older Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Richard M Hoffman; Michael J Barry; Janet L Stanford; Ann S Hamilton; William C Hunt; Mary McNaughton Collins

doi:10.1016/j.amjmed.2005.06.072

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Health Outcomes in Older Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Journal article

Open access

Peer reviewed

Health Outcomes in Older Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Richard M Hoffman, Michael J Barry, Janet L Stanford, Ann S Hamilton, William C Hunt and Mary McNaughton Collins

The American journal of medicine, Vol.119(5), pp.418-425

2006

DOI: 10.1016/j.amjmed.2005.06.072

PMID: 16651054

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Abstract

We compared health-related quality-of-life (HRQOL) outcomes and survival of men with localized prostate cancer who received aggressive treatment with those receiving conservative management. We conducted a population-based cohort study of men aged 75 to 84 years when diagnosed with a clinically localized cancer in 1994 or 1995. We used medical record abstractions and patient surveys to obtain clinical and HRQOL data at diagnosis and 24-month follow-up. We used a propensity score method to adjust for baseline differences between men treated with radical prostatectomy or radiation therapy (n = 175) and men who received hormone therapy or no treatment (n = 290). Propensity scores were used in regression analyses comparing HRQOL outcomes between treatment groups. Overall and disease-specific survivals were estimated with multivariate proportional hazards models. At 24 months following diagnosis, aggressively treated men were more likely to report daily urinary leakage (odds ratio [OR] = 2.9, 95% confidence interval [CI] 1.2-7.0) and to be bothered by urinary problems (OR = 5.1, 95% CI, 1.3-9.1) and sexual problems (OR = 2.8, 95% CI, 1.2-6.3). The adjusted disease-specific mortality hazard ratio was 0.43 (95% CI, 0.15, 1.28), favoring aggressive treatment. However, the absolute 5-year disease-specific survival difference was only 6% (98% vs 92%). Over 80% of all deaths were from other causes. Aggressive treatment was associated with significant decreases in disease-specific HRQOL. However, men who were aggressively treated for localized cancer had a minimally reduced absolute risk of dying from prostate cancer. Physicians and older patients should consider these outcomes in making decisions about screening and treatment.

Prostatectomy

Aged

Prostatic neoplasms

Radiotherapy

Outcome assessment

Details

Title: Subtitle: Health Outcomes in Older Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study
Creators: Richard M Hoffman - Medicine Service, New Mexico VA Health Care System, Albuquerque, NM
Michael J Barry - General Medicine Division, Medical Services, Massachusetts General Hospital, Boston, Mass
Janet L Stanford - Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Wash
Ann S Hamilton - University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, Calif
William C Hunt - University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM
Mary McNaughton Collins - General Medicine Division, Medical Services, Massachusetts General Hospital, Boston, Mass
Resource Type: Journal article
Publication Details: The American journal of medicine, Vol.119(5), pp.418-425
Publisher: Elsevier Inc
DOI: 10.1016/j.amjmed.2005.06.072
PMID: 16651054
ISSN: 0002-9343
eISSN: 1555-7162
Language: English
Date published: 2006
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094628402771

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