Overtreatment of CaP affects QOL for patients. The prostate cancer specific mortality (PCSM) that is decreased by radical prostatectomy (RP) in the Bill-Axelsen study is mostly seen in men younger than 65 years, and most of these men did not have screen-detected CaP. The majority of patients diagnosed in the US are greater than age 65. This present study included 9,018 men from 1992-2002, with more than 5,000 men aged >75 years. 100% had T1-T2 disease and none had initial treatment. This group thus varied from other watchful waiting studies by Albertsen and Johansson.
This population based cohort used the SEER-Medicare data, and subjects had no other cancer, were aged >65 years and had T1-T2 CaP diagnosed in 1992-2002. They assessed CaP related disease morbidities. The median age was 77 years, with 11.7% African-American men and most with Gleason score 5-7 tumors. 64% were stage T1.
The 10-year chance of PCSM was less than 10%, unless it was high risk disease. The death from other causes was over 50%. The cancer morbidity rate was <8%. The overall risk of PCSM in all age groups was 12-15%. This study was population based which limits biased, but it lacked PSA values at diagnosis and only had composite Gleason scores.
Presented by G. Lu-Yao at the American Society of Clinical Oncology (ASCO) - 2008 Genitourinary Cancers Symposium - A Multidisciplinary Approach - February 14-16, 2008 San Francisco, California.
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento.
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