Incidence of Initial Local Therapy Among Men With Lower-Risk Prostate Cancer in the United States

Background: The frequently indolent nature of early-stage prostate cancer in older men and in men with low- or moderate-grade tumors and the demonstration that the survival benefits of radical prostatectomy are primarily among men younger than 65 years have led to concerns about prostate cancer over...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2006-08, Vol.98 (16), p.1134-1141
Main Authors: Miller, David C., Gruber, Stephen B., Hollenbeck, Brent K., Montie, James E., Wei, John T.
Format: Article
Language:English
Subjects:
Aged
Alternatives
Biological and medical sciences
Disease management
Humans
Incidence
Logistic Models
Male
Medical sciences
Medical treatment
Middle Aged
Multivariate Analysis
Nephrology. Urinary tract diseases
Prostate cancer
Prostatectomy
Prostatic Neoplasms - epidemiology
Prostatic Neoplasms - radiotherapy
Prostatic Neoplasms - surgery
Radiotherapy, Adjuvant
Research Design
Risk Assessment
Risk factors
SEER Program
Surgery
Treatment Outcome
Tumors
Tumors of the urinary system
United States - epidemiology
Unnecessary Procedures
Urinary tract. Prostate gland
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Summary:Background: The frequently indolent nature of early-stage prostate cancer in older men and in men with low- or moderate-grade tumors and the demonstration that the survival benefits of radical prostatectomy are primarily among men younger than 65 years have led to concerns about prostate cancer overtreatment. Methods: Using data from 13 Surveillance, Epidemiology, and End Results registries, we performed a retrospective cohort study of 71 602 men who were diagnosed with localized or regional prostate cancer between 2000 and 2002. We quantified the incidence of initial curative therapy (i.e., surgery or radiation therapy) among men with lower-risk cancers as defined by their limited likelihood of either dying from expectantly managed prostate cancer or achieving a survival benefit from local therapy. Stratified analyses and multinomial logistic regression models were used to quantify the absolute and relative rates of curative therapy among men in various age–grade strata. All statistical tests were two-sided. Results: We identified 24 405 men with lower-risk prostate cancers and complete data for the first course of treatment. Initial curative therapy was undertaken in 13 537 of these men (55%); 81% of treated men received radiation therapy. The likelihood of curative therapy, relative to expectant management, varied statistically significantly among lower-risk age–grade strata (all P
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/djj308