Overtreatment of men with early-stage prostate cancer and limited life expectancy

摘要

The study by Daskivich et al in this issue of Cancer breaks down a population-based sample of men aged >66 years taken from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database-all diagnosed with early stage, low-grade prostate cancer-into subgroups by age and comorbidity status. They use the database itself to determine the risk of other-cause mortality within 10 years of diagnosis in these subgroups; this measure is used as a proxy for life expectancy. Then, they seek to demonstrate that patients who have limited life expectancies are frequently receiving aggressive treatment, which is not in accordance with American Urological Association and National Comprehensive Cancer Network guidelines. Toward this end, life expectancies, stratified by age and Charlson Comorbidity Index (CCI) score, are calculated for the sample population. The authors report that life expectancy declines sharply as age and CCI increase. Notably, all groups other than those ages 66 to 74 years with CCI scores of zero have 10-year other-cause mortality rates >=50%, indicating life expectancies < 10 years.