Harlan L C, Potosky A, Gilliland F D, Hoffman R, Albertsen P C, Hamilton A S, Eley J W, Stanford J L, Stephenson R A
Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
J Natl Cancer Inst. 2001 Dec 19;93(24):1864-71. doi: 10.1093/jnci/93.24.1864.
Because of the lack of results from randomized clinical trials comparing the efficacy of aggressive therapies with that of more conservative therapies for clinically localized prostate cancer, men and their physicians may select treatments based on other criteria. We examined the association of sociodemographic and clinical characteristics with four management options: radical prostatectomy, radiation therapy, hormonal therapy, and watchful waiting.
We studied 3073 participants of the Prostate Cancer Outcomes Study diagnosed from October 1, 1994, through October 31, 1995, with clinically localized disease (T1 or T2). Participants completed a baseline survey, and diagnostic and treatment information was abstracted from medical records. Multiple logistic regression analysis identified factors associated with initial treatment. All statistical tests were two-sided.
Patients with clinically localized disease received the following treatments: radical prostatectomy (47.6%), radiation therapy (23.4%), hormonal therapy (10.5%), or watchful waiting (18.5%). Men aged 75 years or older more often received conservative treatment (i.e., hormonal therapy alone or watchful waiting; 57.9% of men aged 75-79 years and 82.1% of men aged 80 years and older) than aggressive treatment (i.e., radical prostatectomy or radiation therapy) (for all age groups, P</=.001). After adjustment for age, clinical stage, baseline prostate-specific antigen level, and histologic grade, the following factors were associated with conservative treatment: history of a heart attack, being unmarried, geographic region, poor pretreatment bladder control, and impotence. In men younger than 60 years, use of aggressive treatment was similar by race/ethnicity (adjusted percentages = 85.5%, 88.1%, and 85.3% for white, African-American, and Hispanic men, respectively). However, among men 60 years old and older, African-American men underwent aggressive treatment less often than did white men or Hispanic men (adjusted percentages for men aged 60-64 years = 67.1%, 84.7%, and 79.2%, respectively; 65-74 years = 64.8%, 73.4%, and 79.5%, respectively; and 75 years old and older = 25.2%, 45.7%, and 36.6%, respectively).
The association of nonclinical factors with treatment suggests that, in the absence of definitive information regarding treatment effectiveness, men diagnosed with prostate cancer should be better informed of the risks and benefits of all treatment options.
由于缺乏比较积极治疗与更保守治疗对临床局限性前列腺癌疗效的随机临床试验结果，男性及其医生可能会基于其他标准选择治疗方法。我们研究了社会人口统计学和临床特征与四种治疗方案的关联：根治性前列腺切除术、放射治疗、激素治疗和观察等待。
我们研究了前列腺癌结局研究的3073名参与者，这些参与者于1994年10月1日至1995年10月31日被诊断为临床局限性疾病（T1或T2）。参与者完成了一项基线调查，并从医疗记录中提取了诊断和治疗信息。多因素逻辑回归分析确定了与初始治疗相关的因素。所有统计检验均为双侧检验。
临床局限性疾病患者接受了以下治疗：根治性前列腺切除术（47.6%）、放射治疗（23.4%）、激素治疗（10.5%）或观察等待（18.5%）。75岁及以上的男性比积极治疗（即根治性前列腺切除术或放射治疗）更常接受保守治疗（即仅激素治疗或观察等待；75 - 79岁男性中57.9%，80岁及以上男性中82.1%）（所有年龄组，P≤.001）。在调整年龄、临床分期、基线前列腺特异性抗原水平和组织学分级后，以下因素与保守治疗相关：心脏病发作史、未婚、地理区域、治疗前膀胱控制不佳和阳痿。在60岁以下的男性中，不同种族/族裔使用积极治疗的情况相似（白人、非裔美国人和西班牙裔男性的调整百分比分别为85.5%、88.1%和85.3%）。然而，在60岁及以上的男性中，非裔美国男性接受积极治疗的频率低于白人男性或西班牙裔男性（60 - 64岁男性的调整百分比分别为67.1%、84.7%和79.2%；65 - 74岁分别为64.8%、73.4%和79.5%；75岁及以上分别为25.2%、45.7%和36.6%）。
非临床因素与治疗的关联表明，在缺乏关于治疗有效性的确切信息时，被诊断为前列腺癌的男性应更好地了解所有治疗方案的风险和益处。
