Leveraging Age and Comorbidity to Optimize Treatment Selection in Men with Recurrent Prostate Cancer
Abstract
Men with biochemical recurrence after definitive therapy for prostate cancer are often treated with early androgen deprivation therapy (ADT) despite a lack of clear evidence of survival benefit. Early ADT is especially risky for older men or those with multiple comorbidities, since it significantly increases risk of cardiovascular mortality in these men. Moreover, as the putative survival advantage associated with early ADT is not realized for many years, for older and sicker men, it is likely that any survival benefit of early ADT is markedly attenuated due to limited longevity. Though an argument could be made for delaying hormonal therapy in these men (especially those with favorable tumor risk characteristics), such a paradigm has yet to be realized due to lack of compelling data. Hypothesis/Objective: We will use the Shared Equal Access Regional Cancer Hospital (SEARCH) database, a nationally representative database of men with prostate cancer treated with radical prostatectomy across 6 VA medical centers, to characterize the impact of age, comorbidity, and tumor risk on competing risks for mortality, treatment variation, and treatment effectiveness in men with biochemical recurrence after radical prostatectomy. This database was developed by and run for the past 16 years by my collaborator, Dr. Stephen Freedland. We hypothesize that: (1) the competing risk of non-cancer mortality will greatly outweigh the risk of cancer mortality in older and/or sicker men with favorable tumor risk; (2) age and comorbidity will have little impact on use of early ADT in men with biochemical recurrence regardless of tumor risk; and (3) the survival benefit from early ADT will be diminished in older and sicker men compared with those who are younger and healthier.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2020
- Accession Number
- AD1127495
Entities
People
- Timothy Daskivich