Title

Treatment Patterns and Overall Survival Outcomes Among Patients Aged 80 yr or Older with High-risk Prostate Cancer

Authors

Benjamin W. Fischer-Valuck, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Brian C. Baumann, Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.
Simon A. Brown, Department of Radiation Oncology, Springfield Clinic, Springfield, IL, USA.
Christopher P. Filson, Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Aaron Weiss, Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Ryan Mueller, Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.
Yuan Liu, Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Randall J. Brenneman, Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.
Martin Sanda, Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Jeff M. Michalski, Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.
Hiram A. Gay, Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.
Yuan James Rao, Department of Radiation Oncology, George Washington University, Washington, DC, USA.
John G. Pattaras, Department of Urology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Ashesh B. Jani, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Bruce Hershatter, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
Sagar A. Patel, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.

Document Type

Journal Article

Publication Date

3-1-2022

Journal

European urology open science

Volume

37

DOI

10.1016/j.euros.2021.12.011

Keywords

High-risk prostate cancer; National Cancer Database; Prostate cancer elderly; Prostate cancer octogenarians

Abstract

Background: Elderly patients diagnosed with high-risk prostate cancer (PCa) present a therapeutic dilemma of balancing treatment of a potentially lethal malignancy with overtreatment of a cancer that may not threaten life expectancy. Objective: To investigate treatment patterns and overall survival outcomes in this group of patients. Design setting and participants: A retrospective cohort study was conducted. We queried the National Cancer Database for high-risk PCa in patients aged 80 yr or older diagnosed during 2004-2016. Intervention: Eligible patients underwent no treatment following biopsy (ie, observation), androgen deprivation therapy (ADT) alone, radiation therapy (RT) alone, RT + ADT, or surgery. Outcome measurements and statistical analysis: Kaplan-Meier, log rank, and multivariate Cox proportional hazard regression was performed to compare overall survival (OS). Results and limitations: A total of 19 920 men were eligible for analysis, and the most common treatment approach was RT + ADT (7401 patients; 37.2%). Observation and ADT alone declined over time (59.3% in 2004 vs 47.5% in 2016). There was no observed difference in OS between observation and ADT alone (adjusted hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.99-1.09; = 0.105). Definitive local treatment was associated with improved OS compared with ADT alone (RT alone, HR 0.54, 95% CI, 0.50-0.59, < 0.0001; ADT + RT, HR 0.48, 95% CI, 0.46-0.50, < 0.0001; surgery, HR 0.50, 95% CI, 0.42-0.59, < 0.0001). Conclusions: This analysis demonstrates that the use of definitive local therapy, including surgery or RT ± ADT, is increasing and is associated with a 50% reduction in overall mortality compared with observation or ADT alone. While prospective validation is warranted, elderly men with high-risk disease eligible for definitive management should be counseled on the risks, including a possible compromise in OS, with deferring definitive management. Patient summary: Elderly men are more often diagnosed with higher-risk prostate cancer but are less likely to receive curative treatment options than younger men. Our analysis demonstrates that for men ≥80 yr of age with high-risk prostate cancer, definitive local therapy, including surgery or radiation therapy and/or androgen deprivation therapy, is associated with a 50% reduction in overall mortality compared with observation or androgen deprivation therapy alone. We therefore recommend that life expectancy (ie, physiologic age) be taken into account, over chronologic age, and that elderly men with good life expectancy (eg, >5 yr; minimal comorbidity) should be offered definitive, life-prolonging therapy.

Department

Radiology

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