| TREATMENT DECISION-MAKING IN VETERANS WITH EARLY STAGE PROSTATE CANCER. Soe Soe Thwin*, Kerri Clough-Gorr, Sanjay Raju, Nicole Kosik, Kelly Cho, John Hermos, Michael Gaziano, (VA-Boston Healthcare System, Boston MA USA) |
| Background: Prostate cancer is the second leading cause of cancer death for men in the US. Similar long term survival rates and functional capacity across different therapies have been reported, but little is known about factors related to therapy decision-making. Objective: We conducted this study to evaluate correlates of treatment decision making in a cohort of US veterans diagnosed with early stage prostate cancer. Methods: We analyzed data from an observational cohort of 921 veterans who were diagnosed with early stage prostate cancer (T0-T3, less than stage D), between 1999 and 2006 at 16 VA centers. We compared demographic and clinical characteristics across therapy type (radical prostatectomy, radiation, observation, and other). Logistic regression methods were employed to determine factors associated with type of therapy received within 2 years of diagnosis. Results: Therapies administered were 30% radical prostatectomy, 44% radiation, 17% observation, and 9% other. Younger age and being comorbidity-free at diagnosis were significantly related to receipt of radical prostatectomy, Odd Ratio(Confidence Interval) = 3.2(2.2-4.7)and 1.8(1.3-2.4) respectively. Moreover, odds of receiving prostatectomy instead of radiation increased if the veteran was both young and comorbidity free. Marital status played an important role in receipt of radical prostatectomy versus other therapies in the very young (<55years) age group. Race, education, family history, psa level, or methods of detection were not determinants of therapy after adjusting for age, comorbidity and marital status. Conclusion: Understanding the interplay between demographic and clinical factors related to treatment of early stage prostate cancer remain an important issue for Veterans Administration which provides health care to approximately 8.7 million veterans annually, 60% of whom are men over 60 years of age. |