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Grant Details

Grant Number: 5R01CA116399-06 Interpret this number
Primary Investigator: Lu-Yao, Grace
Organization: Univ Of Med/Dent Nj-R W Johnson Med Sch
Project Title: Evaluation of Palliative Prostate Cancer Care Among Elderly Men
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Among men, prostate cancer is the most common non-skin cancer. Although the majority of prostate cancer patients are over 65 years of age, outcomes data specific to elderly patients are sparse. This proposal addresses a pressing public health issue: What are the long-term clinical outcomes of the ever-increasing number of elderly patients with localized prostate cancer? This study will focus on outcomes following conservative management and primary androgen deprivation therapy (PADT), the second most common treatment among elderly men despite the absence of data supporting its application. The importance of determining the appropriate use of PADT has increased in urgency because a growing body of literature now demonstrates that ADT use is associated with substantial side effects and healthcare costs. The Institute of Medicine has identified assessment of treatment for localized prostate cancer as a top research priority in its recent comparative effectiveness research priorities report. During the initial funding period we found that survival outcomes have improved substantially over time and early use of PADT was not associated with improve cancer-specific or overall survival for the majority of elderly men with localized prostate cancer. These findings have been cited in numerous treatment guidelines. The major limitations of our initial investigation were limited follow-up and unavailability of key prognostics factors such as detailed Gleason scores and baseline prostate specific antigen (PSA) data. To address these limitations we are proposing a continuation study to provide longer follow-up data and refined outcome estimates incorporating newly available PSA and detailed Gleason scores. This population-based study will use SEER-Medicare linked data (1992 - 2011) to identify study subjects and cancer treatment history. The large sample size (N ~ 66,000) will provide ample statistical power. We will utilize modern methods designed to minimize biases. When complete, this proposed study will provide the largest and longest follow-up data (up to 19 years) on survival and on use of major interventions for cancer complications among elderly men with localized prostate cancer. Our updated data will help clarity any misconception about the potential benefit of PADT, thereby facilitating informed decision-making, decreasing inappropriate treatment, and thus reducing healthcare expenditures while improving quality of life for millions of men.

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Publications

Fracture after androgen deprivation therapy among men with a high baseline risk of skeletal complications.
Authors: Shao YH, Moore DF, Shih W, Lin Y, Jang TL, Lu-Yao GL
Source: BJU Int, 2013 May;111(5), p. 745-52.
EPub date: 2013 Jan 17.
PMID: 23331464
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Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?
Authors: Lu-Yao GL, Albertsen PC, Li H, Moore DF, Shih W, Lin Y, DiPaola RS, Yao SL
Source: Eur Urol, 2012 Dec;62(6), p. 966-72.
EPub date: 2012 May 10.
PMID: 22608160
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The impact of PSA testing frequency on prostate cancer incidence and treatment in older men.
Authors: Shao YH, Albertsen PC, Shih W, Roberts CB, Lu-Yao GL
Source: Prostate Cancer Prostatic Dis, 2011 Dec;14(4), p. 332-9.
EPub date: 2011 Jun 28.
PMID: 21709691
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Treatment profile and complications associated with cryotherapy for localized prostate cancer: a population-based study.
Authors: Roberts CB, Jang TL, Shao YH, Kabadi S, Moore DF, Lu-Yao GL
Source: Prostate Cancer Prostatic Dis, 2011 Dec;14(4), p. 313-9.
EPub date: 2011 Apr 26.
PMID: 21519347
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Patterns and correlates of prostate cancer treatment in older men.
Authors: Roberts CB, Albertsen PC, Shao YH, Moore DF, Mehta AR, Stein MN, Lu-Yao GL
Source: Am J Med, 2011 Mar;124(3), p. 235-43.
PMID: 21396507
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Impact of comorbidity on survival among men with localized prostate cancer.
Authors: Albertsen PC, Moore DF, Shih W, Lin Y, Li H, Lu-Yao GL
Source: J Clin Oncol, 2011 Apr 1;29(10), p. 1335-41.
EPub date: 2011 Feb 28.
PMID: 21357791
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Risk profiles and treatment patterns among men diagnosed as having prostate cancer and a prostate-specific antigen level below 4.0 ng/ml.
Authors: Shao YH, Albertsen PC, Roberts CB, Lin Y, Mehta AR, Stein MN, DiPaola RS, Lu-Yao GL
Source: Arch Intern Med, 2010 Jul 26;170(14), p. 1256-61.
PMID: 20660846
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Diagnosis of localized, screen-detected, prostate cancer--crisis or opportunity?
Authors: Yao SL, Lu-Yao GL
Source: J Natl Cancer Inst, 2010 Jul 7;102(13), p. 919-20.
EPub date: 2010 Jun 18.
PMID: 20562372
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Outcomes of localized prostate cancer following conservative management.
Authors: Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Barry MJ, Zietman A, O'Leary M, Walker-Corkery E, Yao SL
Source: JAMA, 2009 Sep 16;302(11), p. 1202-9.
PMID: 19755699
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Contemporary risk profile of prostate cancer in the United States.
Authors: Shao YH, Demissie K, Shih W, Mehta AR, Stein MN, Roberts CB, Dipaola RS, Lu-Yao GL
Source: J Natl Cancer Inst, 2009 Sep 16;101(18), p. 1280-3.
EPub date: 2009 Aug 27.
PMID: 19713548
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Composite likelihood modeling of neighboring site correlations of DNA sequence substitution rates.
Authors: Deng L, Moore DF
Source: Stat Appl Genet Mol Biol, 2009;8, p. Article 6.
EPub date: 2009 Jan 28.
PMID: 19222389
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Associations of lifestyle and physiologic factors with prostate-specific antigen concentrations: evidence from the National Health and Nutrition Examination Survey (2001-2004).
Authors: Parekh N, Lin Y, Marcella S, Kant AK, Lu-Yao G
Source: Cancer Epidemiol Biomarkers Prev, 2008 Sep;17(9), p. 2467-72.
PMID: 18768517
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Survival following primary androgen deprivation therapy among men with localized prostate cancer.
Authors: Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Yao SL
Source: JAMA, 2008 Jul 9;300(2), p. 173-81.
PMID: 18612114
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