Outcomes of localized prostate cancer following conservative management

Grace L. Lu-Yao, Peter C. Albertsen, Dirk F. Moore, Weichung Shih, Yong Lin, Robert S. DiPaola, Michael J. Barry, Anthony Zietman, Michael O'Leary, Elizabeth Walker-Corkery, Siu Long Yao

Research output: Contribution to journalArticle

326 Citations (Scopus)

Abstract

Context: Most newly diagnosed prostate cancers are clinically localized, and major treatment options include surgery, radiation, or conservative management. Although conservative management can be a reasonable choice, there is little contemporary prostate-specific antigen (PSA)-era data on outcomes with this approach. Objective: To evaluate the outcomes of clinically localized prostate cancer managed without initial attempted curative therapy in the PSA era. Design, Setting, and Participants: A population-based cohort study of men aged 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median of 8.3 years (through December 31, 2007). Competing risk analyses were performed to assess outcomes. Main Outcome Measures: Ten-year overall survival, cancer-specific survival, and major cancer related interventions. Results: Among men who were a median age of 78 years at cancer diagnosis, 10-year prostate cancer-specific mortality was 8.3% (95% confidence interval [CI], 4.2%-12.8%) for men with well-differentiated tumors; 9.1% (95% CI,8.3%-10.1%) for those with moderately differentiated tumors, and 25.6% (95% CI, 23.7%-28.3%) for those with poorly differentiated tumors. The corresponding 10-year risks of dying of competing causes were 59.8% (95%CI, 53.2%-67.8%),57.2% (95% CI, 52.6%-63.9%), and 56.5% (95% CI, 53.6%-58.8%), respectively. Ten-year disease-specific mortality for men aged 66 to 74 years diagnosed with moderately differentiated disease was 60% to 74% lower than earlier studies: 6% (95% CI, 4%-8%) in the contemporary PSA era (1992-2002) compared with results of previous studies (15%-23%) in earlier eras (1949-1992). Improved survival wasalso observed in poorly differentiated disease. The use of chemotherapy (1.6%) ormajor interventions for spinal cord compression (0.9%) was uncommon. Conclusions: Results following conservative management of clinically localized prostate cancer diagnosed from 1992 through 2002 are better than outcomes among patients diagnosed in the 1970s and 1980s. This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care.

Original languageEnglish (US)
Pages (from-to)1202-1209
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume302
Issue number11
DOIs
StatePublished - Sep 16 2009

Fingerprint

Prostatic Neoplasms
Confidence Intervals
Prostate-Specific Antigen
Neoplasms
Survival
SEER Program
Radiation
Spinal Cord Compression
Mortality
Conservative Treatment
Cohort Studies
Outcome Assessment (Health Care)
Drug Therapy
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Lu-Yao, Grace L. ; Albertsen, Peter C. ; Moore, Dirk F. ; Shih, Weichung ; Lin, Yong ; DiPaola, Robert S. ; Barry, Michael J. ; Zietman, Anthony ; O'Leary, Michael ; Walker-Corkery, Elizabeth ; Yao, Siu Long. / Outcomes of localized prostate cancer following conservative management. In: JAMA - Journal of the American Medical Association. 2009 ; Vol. 302, No. 11. pp. 1202-1209.
@article{a974b54774af447f82e0aa03d7572628,
title = "Outcomes of localized prostate cancer following conservative management",
abstract = "Context: Most newly diagnosed prostate cancers are clinically localized, and major treatment options include surgery, radiation, or conservative management. Although conservative management can be a reasonable choice, there is little contemporary prostate-specific antigen (PSA)-era data on outcomes with this approach. Objective: To evaluate the outcomes of clinically localized prostate cancer managed without initial attempted curative therapy in the PSA era. Design, Setting, and Participants: A population-based cohort study of men aged 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median of 8.3 years (through December 31, 2007). Competing risk analyses were performed to assess outcomes. Main Outcome Measures: Ten-year overall survival, cancer-specific survival, and major cancer related interventions. Results: Among men who were a median age of 78 years at cancer diagnosis, 10-year prostate cancer-specific mortality was 8.3{\%} (95{\%} confidence interval [CI], 4.2{\%}-12.8{\%}) for men with well-differentiated tumors; 9.1{\%} (95{\%} CI,8.3{\%}-10.1{\%}) for those with moderately differentiated tumors, and 25.6{\%} (95{\%} CI, 23.7{\%}-28.3{\%}) for those with poorly differentiated tumors. The corresponding 10-year risks of dying of competing causes were 59.8{\%} (95{\%}CI, 53.2{\%}-67.8{\%}),57.2{\%} (95{\%} CI, 52.6{\%}-63.9{\%}), and 56.5{\%} (95{\%} CI, 53.6{\%}-58.8{\%}), respectively. Ten-year disease-specific mortality for men aged 66 to 74 years diagnosed with moderately differentiated disease was 60{\%} to 74{\%} lower than earlier studies: 6{\%} (95{\%} CI, 4{\%}-8{\%}) in the contemporary PSA era (1992-2002) compared with results of previous studies (15{\%}-23{\%}) in earlier eras (1949-1992). Improved survival wasalso observed in poorly differentiated disease. The use of chemotherapy (1.6{\%}) ormajor interventions for spinal cord compression (0.9{\%}) was uncommon. Conclusions: Results following conservative management of clinically localized prostate cancer diagnosed from 1992 through 2002 are better than outcomes among patients diagnosed in the 1970s and 1980s. This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care.",
author = "Lu-Yao, {Grace L.} and Albertsen, {Peter C.} and Moore, {Dirk F.} and Weichung Shih and Yong Lin and DiPaola, {Robert S.} and Barry, {Michael J.} and Anthony Zietman and Michael O'Leary and Elizabeth Walker-Corkery and Yao, {Siu Long}",
year = "2009",
month = "9",
day = "16",
doi = "https://doi.org/10.1001/jama.2009.1348",
language = "English (US)",
volume = "302",
pages = "1202--1209",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "11",

}

Lu-Yao, GL, Albertsen, PC, Moore, DF, Shih, W, Lin, Y, DiPaola, RS, Barry, MJ, Zietman, A, O'Leary, M, Walker-Corkery, E & Yao, SL 2009, 'Outcomes of localized prostate cancer following conservative management', JAMA - Journal of the American Medical Association, vol. 302, no. 11, pp. 1202-1209. https://doi.org/10.1001/jama.2009.1348

Outcomes of localized prostate cancer following conservative management. / Lu-Yao, Grace L.; Albertsen, Peter C.; Moore, Dirk F.; Shih, Weichung; Lin, Yong; DiPaola, Robert S.; Barry, Michael J.; Zietman, Anthony; O'Leary, Michael; Walker-Corkery, Elizabeth; Yao, Siu Long.

In: JAMA - Journal of the American Medical Association, Vol. 302, No. 11, 16.09.2009, p. 1202-1209.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of localized prostate cancer following conservative management

AU - Lu-Yao, Grace L.

AU - Albertsen, Peter C.

AU - Moore, Dirk F.

AU - Shih, Weichung

AU - Lin, Yong

AU - DiPaola, Robert S.

AU - Barry, Michael J.

AU - Zietman, Anthony

AU - O'Leary, Michael

AU - Walker-Corkery, Elizabeth

AU - Yao, Siu Long

PY - 2009/9/16

Y1 - 2009/9/16

N2 - Context: Most newly diagnosed prostate cancers are clinically localized, and major treatment options include surgery, radiation, or conservative management. Although conservative management can be a reasonable choice, there is little contemporary prostate-specific antigen (PSA)-era data on outcomes with this approach. Objective: To evaluate the outcomes of clinically localized prostate cancer managed without initial attempted curative therapy in the PSA era. Design, Setting, and Participants: A population-based cohort study of men aged 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median of 8.3 years (through December 31, 2007). Competing risk analyses were performed to assess outcomes. Main Outcome Measures: Ten-year overall survival, cancer-specific survival, and major cancer related interventions. Results: Among men who were a median age of 78 years at cancer diagnosis, 10-year prostate cancer-specific mortality was 8.3% (95% confidence interval [CI], 4.2%-12.8%) for men with well-differentiated tumors; 9.1% (95% CI,8.3%-10.1%) for those with moderately differentiated tumors, and 25.6% (95% CI, 23.7%-28.3%) for those with poorly differentiated tumors. The corresponding 10-year risks of dying of competing causes were 59.8% (95%CI, 53.2%-67.8%),57.2% (95% CI, 52.6%-63.9%), and 56.5% (95% CI, 53.6%-58.8%), respectively. Ten-year disease-specific mortality for men aged 66 to 74 years diagnosed with moderately differentiated disease was 60% to 74% lower than earlier studies: 6% (95% CI, 4%-8%) in the contemporary PSA era (1992-2002) compared with results of previous studies (15%-23%) in earlier eras (1949-1992). Improved survival wasalso observed in poorly differentiated disease. The use of chemotherapy (1.6%) ormajor interventions for spinal cord compression (0.9%) was uncommon. Conclusions: Results following conservative management of clinically localized prostate cancer diagnosed from 1992 through 2002 are better than outcomes among patients diagnosed in the 1970s and 1980s. This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care.

AB - Context: Most newly diagnosed prostate cancers are clinically localized, and major treatment options include surgery, radiation, or conservative management. Although conservative management can be a reasonable choice, there is little contemporary prostate-specific antigen (PSA)-era data on outcomes with this approach. Objective: To evaluate the outcomes of clinically localized prostate cancer managed without initial attempted curative therapy in the PSA era. Design, Setting, and Participants: A population-based cohort study of men aged 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median of 8.3 years (through December 31, 2007). Competing risk analyses were performed to assess outcomes. Main Outcome Measures: Ten-year overall survival, cancer-specific survival, and major cancer related interventions. Results: Among men who were a median age of 78 years at cancer diagnosis, 10-year prostate cancer-specific mortality was 8.3% (95% confidence interval [CI], 4.2%-12.8%) for men with well-differentiated tumors; 9.1% (95% CI,8.3%-10.1%) for those with moderately differentiated tumors, and 25.6% (95% CI, 23.7%-28.3%) for those with poorly differentiated tumors. The corresponding 10-year risks of dying of competing causes were 59.8% (95%CI, 53.2%-67.8%),57.2% (95% CI, 52.6%-63.9%), and 56.5% (95% CI, 53.6%-58.8%), respectively. Ten-year disease-specific mortality for men aged 66 to 74 years diagnosed with moderately differentiated disease was 60% to 74% lower than earlier studies: 6% (95% CI, 4%-8%) in the contemporary PSA era (1992-2002) compared with results of previous studies (15%-23%) in earlier eras (1949-1992). Improved survival wasalso observed in poorly differentiated disease. The use of chemotherapy (1.6%) ormajor interventions for spinal cord compression (0.9%) was uncommon. Conclusions: Results following conservative management of clinically localized prostate cancer diagnosed from 1992 through 2002 are better than outcomes among patients diagnosed in the 1970s and 1980s. This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care.

UR - http://www.scopus.com/inward/record.url?scp=70349140531&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349140531&partnerID=8YFLogxK

U2 - https://doi.org/10.1001/jama.2009.1348

DO - https://doi.org/10.1001/jama.2009.1348

M3 - Article

C2 - 19755699

VL - 302

SP - 1202

EP - 1209

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 11

ER -