Abstract | IMPORTANCE: OBJECTIVE: DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort of 3295 men with metastatic PCa between January 1995 and December 2009 66 years or older was selected from the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database. EXPOSURES: MAIN OUTCOMES AND MEASURES: Any fractures, peripheral arterial disease, venous thromboembolism, cardiac-related complications, diabetes mellitus, and cognitive disorders. To minimize treatment group biases, the inverse probability of treatment was weighted using the propensity score. Multivariable competing risk regression models were performed with the adjustment of all-cause mortality. Secondary analyses examined the effect of increasing duration of GnRHa treatment. Multivariable logistic regression models examined expenditures. RESULTS: Overall, 3295 men with a primary diagnosis of metastatic PCa treated with GnRHa or orchiectomy were identified between years 1995 and 2009, and in adjusted analyses, patients who received a bilateral orchiectomy had significantly lower risks of experiencing any fractures (hazard ratio [HR], 0.77; 95% CI, 0.62-0.94; P = .01), peripheral arterial disease (HR, 0.65; 95% CI, 0.49-0.87; P = .004), and cardiac-related complications (HR, 0.74; 0.58-0.94; P = .01) compared with those treated with GnRHa. No statistically significant difference was noted between orchiectomy and GnRHa for diabetes and cognitive disorders. In individuals treated with GnRHa for 35 months or more, the increased risk for GnRHa compared with orchiectomy was noted for fractures (HR, 1.80), peripheral arterial disease (HR, 2.25), venous thromboembolism (HR, 1.52), cardiac-related complications (HR, 1.69), and diabetes mellitus (HR, 1.88) (P ≤ .01 for all). At 12 months after PCa diagnosis, the median total expenditures was not significantly different between GnRHa and orchiectomy. CONCLUSIONS AND RELEVANCE:
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Authors | Maxine Sun, Toni K Choueiri, Ole-Petter R Hamnvik, Mark A Preston, Guillermo De Velasco, Wei Jiang, Stacy Loeb, Paul L Nguyen, Quoc-Dien Trinh |
Journal | JAMA oncology
(JAMA Oncol)
Vol. 2
Issue 4
Pg. 500-7
(Apr 2016)
ISSN: 2374-2445 [Electronic] United States |
PMID | 26720632
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Androgen Antagonists
- Antineoplastic Agents, Hormonal
- Gonadotropin-Releasing Hormone
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Topics |
- Aged
- Androgen Antagonists
(adverse effects)
- Antineoplastic Agents, Hormonal
(adverse effects)
- Gonadotropin-Releasing Hormone
(agonists)
- Humans
- Male
- Orchiectomy
(adverse effects)
- Proportional Hazards Models
- Prostatic Neoplasms
(drug therapy, surgery)
- Retrospective Studies
- SEER Program
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