Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?

Grace L. Lu-Yao, Peter C. Albertsen, Hui Li, Dirk F. Moore, Weichung Shih, Yong Lin, Robert S. Dipaola, Siu Long Yao

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective: This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants: This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis: Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations: This study includes 29 775 men who did not receive local therapy for T1-T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2-7 in 1992-2002 and Gleason score 2-6 in 2003-2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08-1.44) and a borderline higher use of any palliative cancer treatment (HR: 1.07; 95% CI, 0.97-1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions: Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.

Original languageEnglish (US)
Pages (from-to)966-972
Number of pages7
JournalEuropean Urology
Volume62
Issue number6
DOIs
StatePublished - Dec 1 2012

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Androgens
Prostatic Neoplasms
Palliative Care
Neoplasms
Therapeutics
Neoplasm Grading
Confidence Intervals
Medicare
Drug Therapy
SEER Program
Urinary Bladder Neck Obstruction
Spinal Cord Compression
Epidemiology
Cohort Studies
Radiotherapy
Survival
Population

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Lu-Yao, Grace L. ; Albertsen, Peter C. ; Li, Hui ; Moore, Dirk F. ; Shih, Weichung ; Lin, Yong ; Dipaola, Robert S. ; Yao, Siu Long. / Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?. In: European Urology. 2012 ; Vol. 62, No. 6. pp. 966-972.
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abstract = "Background: Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective: This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants: This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis: Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations: This study includes 29 775 men who did not receive local therapy for T1-T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2-7 in 1992-2002 and Gleason score 2-6 in 2003-2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25{\%} higher use of chemotherapy (hazard ratio [HR]: 1.25; 95{\%} confidence interval [CI], 1.08-1.44) and a borderline higher use of any palliative cancer treatment (HR: 1.07; 95{\%} CI, 0.97-1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions: Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.",
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Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer? / Lu-Yao, Grace L.; Albertsen, Peter C.; Li, Hui; Moore, Dirk F.; Shih, Weichung; Lin, Yong; Dipaola, Robert S.; Yao, Siu Long.

In: European Urology, Vol. 62, No. 6, 01.12.2012, p. 966-972.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?

AU - Lu-Yao, Grace L.

AU - Albertsen, Peter C.

AU - Li, Hui

AU - Moore, Dirk F.

AU - Shih, Weichung

AU - Lin, Yong

AU - Dipaola, Robert S.

AU - Yao, Siu Long

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background: Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective: This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants: This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis: Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations: This study includes 29 775 men who did not receive local therapy for T1-T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2-7 in 1992-2002 and Gleason score 2-6 in 2003-2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08-1.44) and a borderline higher use of any palliative cancer treatment (HR: 1.07; 95% CI, 0.97-1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions: Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.

AB - Background: Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective: This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants: This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis: Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations: This study includes 29 775 men who did not receive local therapy for T1-T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2-7 in 1992-2002 and Gleason score 2-6 in 2003-2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08-1.44) and a borderline higher use of any palliative cancer treatment (HR: 1.07; 95% CI, 0.97-1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions: Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.

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