Grant Number:	2R01CA116399-05A1 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:	2011

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. PUBLIC HEALTH RELEVANCE: Over 167,000 men are diagnosed annually with cancer confined to the prostate. Lack of unbiased, representative outcomes data is a major barrier in deciding upon the best course of clinical management. This study aims to fill the knowledge gap to facilitate informed decisions.




Comparative Effectiveness of Radical Prostatectomy With Adjuvant Radiotherapy Versus Radiotherapy Plus Androgen Deprivation Therapy for Men With Advanced Prostate Cancer.
Authors: Jang T.L. , Patel N. , Faiena I. , Radadia K.D. , Moore D.F. , Elsamra S.E. , Singer E.A. , Stein M.N. , Eastham J.A. , Scardino P.T. , et al. .
Source: Cancer, 2018-09-25 00:00:00.0; , .
EPub date: 2018-09-25 00:00:00.0.
PMID: 30252932
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Reply to Michael Froehner, Rainer Koch, Manfred P. Wirth's Letter to the Editor re: Grace L. Lu-Yao, Peter C. Albertsen, Dirk F. Moore, Yong Lin, Robert S. DiPaola, Siu-Long Yao. Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer. Eur Urol 2015;68:805-11.
Authors: Albertsen P.C. , Lu-Yao G.L. .
Source: European Urology, 2016 Jun; 69(6), p. e131-2.
EPub date: 2015-12-22 00:00:00.0.
PMID: 26706104
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Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer.
Authors: Lu-Yao G.L. , Albertsen P.C. , Moore D.F. , Lin Y. , DiPaola R.S. , Yao S.L. .
Source: European Urology, 2015 Nov; 68(5), p. 805-11.
PMID: 25800944
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Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer.
Authors: Lu-Yao G.L. , Albertsen P.C. , Moore D.F. , Shih W. , Lin Y. , DiPaola R.S. , Yao S.L. .
Source: Jama Internal Medicine, 2014 Sep; 174(9), p. 1460-7.
PMID: 25023796
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Fracture after androgen deprivation therapy among men with a high baseline risk of skeletal complications.
Authors: Shao Y.H. , Moore D.F. , Shih W. , Lin Y. , Jang T.L. , Lu-Yao G.L. .
Source: Bju International, 2013 May; 111(5), p. 745-52.
PMID: 23331464
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Words of wisdom: re: radical prostatectomy versus observation for localized prostate cancer.
Authors: Lu-Yao G. .
Source: European Urology, 2013 Apr; 63(4), p. 767.
PMID: 23438392
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Does primary androgen-deprivation therapy delay the receipt of secondary cancer therapy for localized prostate cancer?
Authors: Lu-Yao G.L. , Albertsen P.C. , Li H. , Moore D.F. , Shih W. , Lin Y. , DiPaola R.S. , Yao S.L. .
Source: European Urology, 2012 Dec; 62(6), p. 966-72.
PMID: 22608160
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Treatment profile and complications associated with cryotherapy for localized prostate cancer: a population-based study.
Authors: Roberts C.B. , Jang T.L. , Shao Y.H. , Kabadi S. , Moore D.F. , Lu-Yao G.L. .
Source: Prostate Cancer And Prostatic Diseases, 2011 Dec; 14(4), p. 313-9.
PMID: 21519347
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The impact of PSA testing frequency on prostate cancer incidence and treatment in older men.
Authors: Shao Y.H. , Albertsen P.C. , Shih W. , Roberts C.B. , Lu-Yao G.L. .
Source: Prostate Cancer And Prostatic Diseases, 2011 Dec; 14(4), p. 332-9.
PMID: 21709691
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Words Of Wisdom: Re: Active Surveillance Compared With Initial Treatment For Men With Low-risk Prostate Cancer: A Decision Analysis
Authors: Lu-Yao,G.L. .
Source: European Urology, 2011 Aug; 60(2), p. 393.
PMID: 21703967
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Impact of comorbidity on survival among men with localized prostate cancer.
Authors: Albertsen P.C. , Moore D.F. , Shih W. , Lin Y. , Li H. , Lu-Yao G.L. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2011-04-01 00:00:00.0; 29(10), p. 1335-41.
EPub date: 2011-04-01 00:00:00.0.
PMID: 21357791
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The Science And Art Of Prostate Cancer Screening
Authors: Yao,S.L. , Lu-Yao,G.L. .
Source: Journal Of The National Cancer Institute, 2011-03-16 00:00:00.0; 103(6), p. 450-1.
PMID: 21350220
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Patterns and correlates of prostate cancer treatment in older men.
Authors: Roberts C.B. , Albertsen P.C. , Shao Y.H. , Moore D.F. , Mehta A.R. , Stein M.N. , Lu-Yao G.L. .
Source: The American Journal Of Medicine, 2011 Mar; 124(3), p. 235-43.
PMID: 21396507
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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 Y.H. , Albertsen P.C. , Roberts C.B. , Lin Y. , Mehta A.R. , Stein M.N. , DiPaola R.S. , Lu-Yao G.L. .
Source: Archives Of Internal Medicine, 2010-07-26 00:00:00.0; 170(14), p. 1256-61.
PMID: 20660846
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Diagnosis of localized, screen-detected, prostate cancer--crisis or opportunity?
Authors: Yao S.L. , Lu-Yao G.L. .
Source: Journal Of The National Cancer Institute, 2010-07-07 00:00:00.0; 102(13), p. 919-20.
EPub date: 2010-07-07 00:00:00.0.
PMID: 20562372
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Contemporary risk profile of prostate cancer in the United States.
Authors: Shao Y.H. , Demissie K. , Shih W. , Mehta A.R. , Stein M.N. , Roberts C.B. , Dipaola R.S. , Lu-Yao G.L. .
Source: Journal Of The National Cancer Institute, 2009-09-16 00:00:00.0; 101(18), p. 1280-3.
EPub date: 2009-09-16 00:00:00.0.
PMID: 19713548
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Outcomes of localized prostate cancer following conservative management.
Authors: Lu-Yao G.L. , Albertsen P.C. , Moore D.F. , Shih W. , Lin Y. , DiPaola R.S. , Barry M.J. , Zietman A. , O'Leary M. , Walker-Corkery E. , et al. .
Source: Jama, 2009-09-16 00:00:00.0; 302(11), p. 1202-9.
PMID: 19755699
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Composite likelihood modeling of neighboring site correlations of DNA sequence substitution rates.
Authors: Deng L. , Moore D.F. .
Source: Statistical Applications In Genetics And Molecular Biology, 2009; 8, p. Article 6.
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 A.K. , Lu-Yao G. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 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 G.L. , Albertsen P.C. , Moore D.F. , Shih W. , Lin Y. , DiPaola R.S. , Yao S.L. .
Source: Jama, 2008-07-09 00:00:00.0; 300(2), p. 173-81.
PMID: 18612114
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