Older men less likely to receive definitive therapy for prostate cancer

Older men with unfavorable-risk prostate cancer appeared less likely to receive definitive therapy and more likely to receive primary androgen deprivation therapy, study data showed.

“Prostate cancer is the most common malignancy and second most common cause of cancer-related death among men in the United States,” Paul L. Nguyen, MD, associate professor of radiation oncology at Harvard Medical School, and colleagues wrote. “Previous studies have demonstrated that elderly patients with cancer are often undertreated, particularly as it pertains to local therapy.”

The researchers used the National Cancer Data Base to identify 411,343 patients diagnosed with either intermediate-risk or high-risk prostate cancer between 2004 and 2012. Nguyen and colleagues examined associations between age and receipt of definitive therapy, defining definitive therapy as radical prostatectomy or radiotherapy. They also evaluated associations between age and receipt of androgen deprivation therapy among patients who did not receive definitive therapy.

Most patients with high-risk (87.1%) and intermediate-risk (91.9%) disease underwent definitive therapy. Nearly all men aged younger than 60 years (93.7%) received definitive therapy. This proportion decreased as patients increased in age, followed by those aged 60 to 64 years (92.1%), 65 to 69 years (90.8%), 70 to 74 years (87.6%), 75 to 79 years (80.9%), and 80 years or older (55.2%).

The same held true for patients with intermediate-risk disease, with 96.1% of men aged younger than 60 years receiving definitive therapy, followed by those aged 60 to 64 years (94.7%), 65 to 69 years (93.4%), 70 to 74 years (89.7%), 75 to 79 years (82.7%) and 80 years or older (62.8%).

Overall, older age appeared linked with a lower likelihood of receiving definitive therapy and an increased likelihood of receiving androgen deprivation therapy in both high- and intermediate-risk patients (P < .001 for all).

“This phenomenon may be because of provider and patient perception that these patients may not benefit from definitive therapy because of competing risks [for] mortality, and yet providers and patients would still prefer to treat the cancer,” Nguyen and colleagues wrote. “Notably, approximately 40% to 45% of patients aged [80 years or older] who had unfavorable-risk disease did not receive definitive therapy. These findings are alarming given the dismal outcomes of conservatively managed unfavorable-risk prostate cancer and suggest an underuse of effective definitive therapy in the elderly.” – by Andy Polhamus

Disclosures: Nguyen reports fees from Dendreon, Ferring, Genome Dx, Medivation, Nanobiotix, as well as research support from Astellas and Janssen. Please see the full study for a list of all other researchers’ relevant financial disclosures.