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Key Points Question What factors are associated with the receipt of nondefinitive therapy and survival among patients aged 70 years and younger who are diagnosed with high-risk prostate cancer? Findings In this cohort study of 72 036 patients aged 70 years and younger with high-risk prostate cancer entered in the National Cancer Database, we found that 7.3% of patients received nondefinitive therapy; moreover, receipt of nondefinitive therapy was associated with inferior overall survival. Insurance status and race/ethnicity were independently associated with receipt of nondefinitive therapy. Meaning The findings of this study suggest that significant barriers to life-extending treatment options for younger patients with high-risk prostate cancer remain.
This cohort study identifies sociodemographic and health-related factors associated with receipt of nondefinitive therapy among patients aged 70 years and younger with high-risk prostate cancer.
Importance Multiple randomized clinical trials have shown that definitive therapy improves overall survival among patients with high-risk prostate cancer. However, many patients do not receive definitive therapy because of sociodemographic and health-related factors. Objective To identify factors associated with receipt of nondefinitive therapy (NDT) among patients aged 70 years and younger with high-risk prostate cancer. Design, Setting, and Participants This cohort study identified 72 036 patients aged 70 years and younger with high-risk prostate cancer and Charlson Comorbidity Index scores of 2 or less who were entered in the National Cancer Database between January 2004 and December 2014. Data analysis was conducted from November 2018 to December 2019. Exposure Receipt of NDT as an initial treatment approach. Main Outcomes and Measures Survival rates were compared based on receipt of definitive therapy or NDT, and sociodemographic and health-related factors were associated with the type of therapy received. Residual life expectancy was estimated from the National Center for Health Statistics to calculate person-years of life lost. Results A total of 72 036 men with a median (range) age of 63 (30-70) years, Charlson Comorbidity Index scores of 2 or less, and high-risk prostate cancer without regional lymph node or distant metastatic disease were analyzed. Among eligible patients, 5252 (7.3%) received NDT as an initial therapeutic strategy. On univariate and multivariate analyses, NDT was associated with worse overall survival (univariate analysis hazard ratio, 2.54; 95% CI, 2.40-2.69; P