Abstract
Background
Brachytherapy (BT) is a widely used treatment modality for elderly patients with localized prostate cancer (PCa).
Objective
To describe the patterns of BT use in octo- and nonagenarians treated for localized PCa in the USA. We hypothesized that most individuals treated with BT should remain alive for at least 10 years. We also postulated that BT should ideally be administered as monotherapy.
Patients and methods
Using the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, 2701 octo- and nonagenarians treated with BT between 1992 and 2009 were identified. Cumulative incidence rates and smoothed cumulative incidence plots were used.
Results
In patients with low-risk characteristics, 40 % received BT alone; 27 % received BT combined with ADT; 19 % received BT and EBRT; and 14 % received BT combined with both ADT and EBRT. Of intermediate-to-high-risk patients, 19 % received BT alone; 16 % received BT combined with ADT; 19 % received BT combined with EBRT; and 45 % received BT together with ADT and EBRT. Overall survival rate was 79 and 47 % at 5 and 10 years.
Conclusions
Less than half of elderly treated with BT remain alive at 10 years of follow-up. Moreover, the vast majority of those individuals not only receives BT, but is also exposed to two or even three combined therapy modalities. These findings are worrisome.
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Acknowledgments
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors declare no conflicts of interest in preparing this article.
Ethical standard
This manuscript found approval by SEER-Medicare. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Roger Valdivieso and Katharina Boehm have contributed equally.
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Valdivieso, R., Boehm, K., Meskawi, M. et al. Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians. World J Urol 33, 1985–1991 (2015). https://doi.org/10.1007/s00345-015-1553-0
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DOI: https://doi.org/10.1007/s00345-015-1553-0