The long-term objective of this application is to improve prostate cancer care for elderly patients. Although prostate cancer is common, outcomes data specific for elderly patients (aged 75 years or older) are sparse. In the past decade, the use of primary androgen deprivation therapy (PADT) for localized prostate cancer has increased by more than 25% among elderly men, perhaps because it is often perceived as safer than the alternatives of surgery or radiation. Disturbingly, among elderly patients the risk of being hospitalized for fractures within five year of cancer diagnosis (20%) increased by more than 50% after 5 years of PADT use compared with patients without any androgen deprivation. Disease-specific mortality and serious cancer- related complications; however, are similar between long-term and short-term PADT users. Because of the concerns about the potential side effects of PADT, the Prostate Cancer Progress Review Groups has identified assessment of PADT as a top priority in the current prostate cancer research plan. The primary objectives of the study will be to define the prognosis of elderly patients with localized prostate cancer, in term of fractures, overall and disease-specific survival, and serious-cancer related complications, following PADT and conservative management. Furthermore, this proposed study will assess these outcomes as a function of the duration of PADT exposure and quantify the excess risk associated with PADT use. This population-based study will use the SEER-Medicare linked data to identify eligible patients diagnosed in 1992-2002. Because of its large sample size (about 38,000 men with up to 12 years of follow-up), this study will have ample statistical power. The data will be analyzed utilizing modern methods designed to minimize biases (e.g., propensity scores, prospective eligibility criteria, multivariate analysis). The findings of this study will be important for informed decision making, planning for future trials, and developing strategies to improve the quality of care. Lay Description-About 69,000 new prostate cancer cases are diagnosed among men over age 75 each year. This study is to provide the probabilities of various clinical outcomes following two commonly used treatment options: deferred treatment and hormonal therapy. The findings of this study will provide benchmark references to help elderly patients weigh the potential risks and benefits of alternative approaches and to facilitate treatment decision-making. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA116399-03
Application #
7467287
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Shavers, Vickie L
Project Start
2006-08-01
Project End
2010-07-31
Budget Start
2008-08-01
Budget End
2009-07-31
Support Year
3
Fiscal Year
2008
Total Cost
$241,207
Indirect Cost
Name
University of Medicine & Dentistry of NJ
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
617022384
City
Piscataway
State
NJ
Country
United States
Zip Code
08854
Lu-Yao, Grace L; Albertsen, Peter C; Moore, Dirk F et al. (2015) Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer. Eur Urol 68:805-11
Lu-Yao, Grace L; Albertsen, Peter C; Moore, Dirk F et al. (2014) Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer. JAMA Intern Med 174:1460-7
Shao, Yu-Hsuan; Moore, Dirk F; Shih, Weichung et al. (2013) Fracture after androgen deprivation therapy among men with a high baseline risk of skeletal complications. BJU Int 111:745-52
Lu-Yao, Grace L; Albertsen, Peter C; Li, Hui et al. (2012) Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer? Eur Urol 62:966-72
Roberts, Calpurnyia B; Albertsen, Peter C; Shao, Yu-Hsuan et al. (2011) Patterns and correlates of prostate cancer treatment in older men. Am J Med 124:235-43
Albertsen, Peter C; Moore, Dirk F; Shih, Weichung et al. (2011) Impact of comorbidity on survival among men with localized prostate cancer. J Clin Oncol 29:1335-41
Roberts, C B; Jang, T L; Shao, Yu-Hsuan et al. (2011) Treatment profile and complications associated with cryotherapy for localized prostate cancer: a population-based study. Prostate Cancer Prostatic Dis 14:313-9
Shao, Y-H; Albertsen, P C; Shih, W et al. (2011) The impact of PSA testing frequency on prostate cancer incidence and treatment in older men. Prostate Cancer Prostatic Dis 14:332-9
Shao, Yu-Hsuan; Albertsen, Peter C; Roberts, Calpurnyia B et al. (2010) Risk profiles and treatment patterns among men diagnosed as having prostate cancer and a prostate-specific antigen level below 4.0 ng/ml. Arch Intern Med 170:1256-61
Yao, Siu-Long; Lu-Yao, Grace L (2010) Diagnosis of localized, screen-detected, prostate cancer--crisis or opportunity? J Natl Cancer Inst 102:919-20

Showing the most recent 10 out of 15 publications