Many Elderly Men with Advanced PCa Receive No Treatment

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Nearly one quarter of men with stage IV prostate cancer (PCa) receive no treatment for the malignancy, data show.

Eberechukwu Onukwugha, PhD, of the University of Maryland School of Pharmacy in Baltimore, and colleagues examined the treatment of 9,106 elderly men with advanced PCa and how they were managed. The investigators analyzed 1994-2002 data from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database. The researchers examined the visits and treatments and compared patients with and without post-urologist medical oncologist/hematologist (PUMOH) visits.

The researchers, who reported their study findings online in Urology, found that 77% of patients received treatment for their cancer and 85% of treated patients had a subsequent visit with a urologist. Among the patients who were treated, 43% saw only the urologist, 41% saw a medical oncologist/hematologist, and 32% saw a radiation oncologist.

Among the 5,435 patients who saw a urologist, 16% received chemotherapy and the adjusted odds of receiving chemotherapy were 7.2 times greater among those with a PUMOH visit.  African Americans and the oldest men in the cohort were less likely to receive chemotherapy for their advanced PCa than other subjects.

In the past, the role of the medical oncologist/hematologist has been rather limited because chemotherapy was considered to have minimal activity against advanced PCa.  However, two landmark randomized phase 3 studies provide evidence for the survival benefits of chemotherapy in metastatic castration-resistant prostate cancer (CRPC).  In addition, the approval of second-line cabazitaxel after docetaxel for men with CRPC has further demonstrated an important role of chemotherapy in the medical management of men with advanced PCa..

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