Change search
ReferencesLink to record
Permanent link

Direct link
Undertreatment of Men in Their Seventies with High-risk Nonmetastatic Prostate Cancer
Show others and affiliations
2015 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 68, no 1, 53-58 p.Article in journal (Refereed) Published
Abstract [en]

Background: Many elderly men with high-risk nonmetastatic prostate cancer (HRnMPCa) do not receive radical treatment, despite the high mortality associated with conservative management. Objective: To investigate how age and comorbidity affect treatment of men with HRnMPCa. Design, setting, and participants: This was an observational nationwide register study during 2001-2012. We identified 19 190 men of <80 yr of age diagnosed with HRnMPCa in the National Prostate Cancer Register of Sweden and 95 948 age-matched men without prostate cancer in the register of the total population. Outcome measurements and statistical analysis: The outcome was the proportion of men with HRnMPCa receiving radical treatment (radical prostatectomy or radiotherapy). Vital status and the Charlson comorbidity index (CCI) were obtained from nationwide registers. The 10-yr survival of men without prostate cancer, stratified by age and CCI, was used as a measure of the life expectancy of the men with prostate cancer. Results and limitations: The proportions receiving radical treatment varied with life expectancy among men younger than 70 yr, whereas use of these treatments did not match the long life expectancy of men in their seventies with CCI 0-1. Only 10% of men aged 75-80 yr with CCI 0 received radical treatment despite 52% probability of 10-yr life expectancy, compared with approximately half of the men younger than 70 yr with a similar life expectancy. The use of radical treatment for HRnMPCa increased with time in all Swedish counties, but a threefold difference between counties remained in 2009-2012 for patients aged 70-80 yr with CCI 0-1. Uncertain external validity is a study limitation, and the impact of physician versus patient preferences on treatment selection could not be assessed. Conclusions: Otherwise healthy men in their seventies with HRnMPCa were less likely to receive radical treatment than younger men with a similar life expectancy, although increasing use of radical treatment was observed during the study period. Our findings highlight the need for improved methods for clinical decision-making, including improved assessment of life expectancy. Patient summary: We performed a nationwide register study that showed that many healthy men in their seventies live for at least another 10 yr. Despite this long life expectancy, men in their seventies with high-risk nonmetastatic prostate cancer were often not treated with radical prostatectomy or radiotherapy, possibly because their life expectancy was underestimated. Our study highlights the need for improved clinical decision-making, which should incorporate an assessment of the patient's life expectancy.

Place, publisher, year, edition, pages
2015. Vol. 68, no 1, 53-58 p.
Keyword [en]
Prostatic neoplasms, Treatment, Epidemiology, Age, Comorbidity
National Category
Urology and Nephrology
URN: urn:nbn:se:umu:diva-106002DOI: 10.1016/j.eururo.2014.12.026ISI: 000355932000018PubMedID: 25813688OAI: diva2:840146
Available from: 2015-07-07 Created: 2015-07-03 Last updated: 2015-07-07Bibliographically approved

Open Access in DiVA

fulltext(1593 kB)54 downloads
File information
File name FULLTEXT01.pdfFile size 1593 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Stattin, Pär
By organisation
Urology and Andrology
In the same journal
European Urology
Urology and Nephrology

Search outside of DiVA

GoogleGoogle Scholar
Total: 54 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 96 hits
ReferencesLink to record
Permanent link

Direct link