Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Shiyi Wang

Abstract

Background Prostate cancer is an aging-related disease. As the result of the radiation are of STAMPEDE trial came out, major shifts in the use of local therapy (LT) are expected for men newly diagnosed with locally advanced and metastatic disease. This study aims to determine the role of patient age on LT.

Methods We identified 6882 and 37382 locally advanced and metastatic prostate cancer diagnosed in 2004-2014 using the National Cancer Database (NCDB). We used logistic multivariable regression to determine the role of age in the receipt of prostate and/or pelvic radiation or radical prostatectomy after adjusting for demographic and clinical factors. Results Among patients with locally advanced disease, 3,559 (52%) patients received definitive local therapy as their first course of therapy, including 2508 (36%) radiation and 1,323 (19%) radical prostatectomy (RP). Among patients newly diagnosed with M1 disease, 2371 (6.3%) patients received definitive local therapy. 1873 (5.0%) and 537 (1.4%) patients received radiation therapy and RP respectively. In the multivariable analysis (MVA), adjusted for clinical characteristics and demographics, compared with men age <50 >years, the odds ratios for receiving local treatment were 0.36 (95% CI: 0.26-0.48) and 0.48 (95% CI: 0.37-0.60) for men ≥70 in locally advanced and metastatic disease respectively.

Conclusion We found that local therapy was undertaken in the majority of men with regional disease, and less common in the metastatic setting. Age was a major determinant of the receipt of any local therapy, as well as the selection of prostatectomy or radiation therapy.

Comments

This is an Open Access Thesis.

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