Overtreatment of Prostate Cancer Among Men With Limited Longevity in the Active Surveillance Era
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View abstract on PubMed
Summary
This summary is machine-generated.Overtreatment of prostate cancer in men with limited life expectancy (LE) has increased, particularly for intermediate- and high-risk disease. This trend persisted despite active surveillance, with radiotherapy being the predominant treatment.
Area Of Science
- Urology
- Oncology
- Health Services Research
Background
- Men with limited life expectancy (LE) have historically faced overtreatment for prostate cancer.
- The increasing adoption of active surveillance raises questions about the persistence of overtreatment in this population.
- Understanding how overtreatment varies by tumor risk and treatment modality is crucial for optimizing patient care.
Purpose Of The Study
- To determine if overtreatment rates for men with limited LE have persisted in the era of active surveillance.
- To investigate whether overtreatment patterns differ based on prostate cancer tumor risk.
- To analyze variations in overtreatment across different treatment types (surgery vs. radiotherapy).
Main Methods
- A cohort study was conducted within the Veterans Affairs health system, including men diagnosed with clinically localized prostate cancer between 2000 and 2019.
- Life expectancy (LE) was estimated using the validated age-adjusted Prostate Cancer Comorbidity Index (PCCI).
- Treatment trends were assessed using stratified linear and log-linear Poisson regression, analyzing aggregate data and subgroups based on PCCI scores and tumor risk.
Main Results
- Among men with LE < 10 years, definitive treatment for low-risk disease decreased, but increased significantly for intermediate-risk disease (from 37.6% to 59.8%).
- For men with LE < 5 years, definitive treatment for high-risk disease increased substantially (from 17.3% to 46.5%).
- Radiotherapy was the predominant definitive treatment, with its use increasing for intermediate- and high-risk disease in men with limited LE.
Conclusions
- The study suggests an increase in overtreatment of prostate cancer for men with limited LE and intermediate- to high-risk disease within the VA system.
- This trend appears to be driven primarily by the increased use of radiotherapy.
- Findings highlight the need for careful consideration of LE and tumor risk in treatment decisions for prostate cancer.
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