Survival in men older than 75 years with low- and intermediate-grade prostate cancer managed with watchful waiting with active surveillance

作     者：Tzuyung D.Kou Siran M.Koroukian Pingfu Fu Derek Raghavan Gregory S.Cooper Li Li 

作者机构：Department of Epidemiology and BiostatisticsCase Western Reserve University School of MedicineClevelandOHUSA Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA Levine Cancer InstituteCarolinas Healthcare SystemCharlotteNCUSA Department of Family Medicine-Research DivisionCase Western Reserve University School of MedicineClevelandOHUSA 

出 版 物：《Family Medicine and Community Health》 (家庭医学与社区卫生（英文）)

年 卷 期：2015年第3卷第3期

页      面：25-36页

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 100214[医学-肿瘤学] 10[医学] 

基　　金：by grants from the National Cancer Institute(U54 CA-116867-01 to Li Li) the National Institute of Aging(P20 CA10373 to Li Li) Siran M.Koroukian was supported by a Career Development Grant from the National Cancer Institute(K07 CA096705) 

主　　题：Epidemiology watchful waiting prostate cancer 

摘      要：Objective:Recent studies have reported the underuse of active surveillance or watchful wait-ing for low-risk prostate cancer in the United *** study examined prostate cancer-specific and all-cause death in elderly patients older than 75 years with low-risk tumors managed with active treatment versus watchful waiting with active surveillance(WWAS).Methods:We performed survival analysis in a cohort of 18,599 men with low-risk tumors(early and localized tumors)who were 75 years or older at the time of prostate cancer diagnosis in the linked Surveillance,Epidemiology,and End Results(SEER)-Medicare database(from 1992 to 1998)and who were followed up through December *** was defined as having an-nual screening for prostate-specific antigen and/or digital rectal examination during the follow-up *** risks of prostate cancer-specific and all-cause death were compared by Cox regression *** propensity score matching technique was used to address potential selection ***:In patients with well-differentiated(Gleason score 2-4)and localized disease,those managed with WWAS without delayed treatment had higher risk of all-cause death(hazard ratio 1.20,95%confidence interval 1.13-1.28)but a substantially lower risk of prostate cancer-specific death(hazard ratio 0.62,confidence interval 0.51-0.75)than patients undergoing active *** managed with WWAS with delayed treatment had comparable mortality ***-tivity analyses based on propensity score matching yielded similar ***:In men older than 75 years with well-differentiated and localized prostate cancer,WWAS without delayed treatment had a lower risk of prostate cancer-specific death and compa-rable all-cause death as compared with active *** patients in whom treatment was delayed had comparable mortality *** results support WWAS as an initial management option for older men with well-differentiated and localized prostate cancer.