B Prostate cancer

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A recently published model 18 addressed an important question: what should be the initial treatment of prostate cancer in elderly men? Radical prostatectomy, external beam radiation therapy, or watchful waiting? The

Figure 1.

Threshold RR10 for an absolute 1% reduction in relapse and mortality risks (ER+ tumors). On the left are the threshold RR10s for an absolute 1% reduction in relapse risk at 10 years. On the right are the threshold RR10s for an absolute 1% reduction in mortality risk at 10 years or, if, at 5 years. Graphs are organized from top to bottom with increasing level of comorbidity. Chemotherapy, gray area; tamoxifen, dotted area. The line in the middle of each band represents the baseline effectiveness of each treatment (50% for tamoxifen, 18% for chemotherapy). The bands represent the boundaries of the sensitivity analysis on that effectiveness (42% to 58% for tamoxifen, 10% to 26% for chemotherapy). (Reproduced with permission from Extermann 00.)

Figure 1.

Threshold RR10 for an absolute 1% reduction in relapse and mortality risks (ER+ tumors). On the left are the threshold RR10s for an absolute 1% reduction in relapse risk at 10 years. On the right are the threshold RR10s for an absolute 1% reduction in mortality risk at 10 years or, if, at 5 years. Graphs are organized from top to bottom with increasing level of comorbidity. Chemotherapy, gray area; tamoxifen, dotted area. The line in the middle of each band represents the baseline effectiveness of each treatment (50% for tamoxifen, 18% for chemotherapy). The bands represent the boundaries of the sensitivity analysis on that effectiveness (42% to 58% for tamoxifen, 10% to 26% for chemotherapy). (Reproduced with permission from Extermann 00.)

authors subclassified the cancers into three grades: Gleason 2-4, 5-7, 810. Their results are shown in Figure 2. They also analyzed the impact of comorbidity on the outcome. In men with Gleason 5-7 cancer, radical prostatectomy, but not radiation therapy resulted in higher quality adjusted life expectancy (QALE) for patients with mild comorbidity up to age 75, and men with moderate comorbidity up to age 65. For aggressive disease, potentially curative therapy improves QALE in men with even moderate comorbidity up to age 75.

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