Abstract
Purpose
There is no contemporary proof of cancer-control benefits in octogenarian clinically localized prostate cancer (PCa) patients with life expectancy (LE) < 10 years. Therefore, cancer-specific mortality (CSM) rates after external beam radiation therapy (EBRT) vs. no local treatment (NLT) were tested in octogenarian PCa patients with LE < 10 years.
Methods
Within the surveillance, epidemiology, and end results database (2004–2015), we identified 22,361 octogenarian clinically localized PCa patients who either received EBRT or NLT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses (MCR) were used after propensity score matching. Sensitivity analyses were performed according to D’Amico risk groups and LE > 5 years.
Results
Of all, 7325 (32.8%) received EBRT vs. 15,036 (67.2%) received NLT. Rates of EBRT significantly increased over time (25.0–42.4%). Overall, 10-year CSM rates were 10.6% vs. 17.0% and 10-year other-cause mortality rates were 50.3% vs. 58.1%, in EBRT vs. NLT patients (both p < 0.001). In MCR focusing on the overall cohort, EBRT represented an independent predictor of lower CSM (hazard ratio: 0.5). In sensitivity analyses, hazard ratios of 0.5 (p < 0.001), 0.5 (p < 0.001) and 0.8 (p = 0.5) were, respectively, recorded in D’Amico high-, intermediate- and low-risk patients. In sensitivity analyses addressing patients with LE > 5 years virtually the same results were recorded.
Conclusions
In octogenarian patients with LE < 10 years, EBRT seems to be associated with lower CSM in D’Amico high-risk, as well as in D’Amico intermediate-risk patients relative to their NLT counterparts. Based on these observations, greater consideration for EBRT may be given in octogenarian patients.
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References
Sanda MG et al (2018) Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol 199:683–690
EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1. https://doi.org/10.1016/j.eururo.2016.08.003
Carroll PH, Mohler JL (2018) NCCN guidelines updates: prostate cancer and prostate cancer early detection. J Natl Compr Cancer Netw 16:620–623
Abdollah F et al (2011) A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol 59:88–95
Dell’Oglio P et al (2016) Survival after conservative management versus external beam radiation therapy in elderly patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 96:1037–1045
Epstein JI, Allsbrook WC, Amin MB, Egevad LL, ISUP Grading Committee (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29:1228–1242
Noone A-M et al (2017) Cancer incidence and survival trends by subtype using data from the Surveillance Epidemiology and End Results program, 1992–2013. Cancer Epidemiol Biomark 26:632–641
Preisser F et al (2018) Validation of the social security administration life tables (2004–2014) in localized prostate cancer patients within the Surveillance, Epidemiology, and End Results database. Eur Urol Focus. https://doi.org/10.1016/j.euf.2018.05.006
D’Amico AV et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969–974
Actuarial Life Table. https://www.ssa.gov/oact/STATS/table4c6.html. Accessed 3 Feb 2019
Epstein JI et al (2016) A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 69:428–435
Anderson JR, Cain KC, Gelber RD (1983) Analysis of survival by tumor response. J Clin Oncol 1:710–719
Lee HJ, Lee A, Huang HH, Lau WKO (2018) Primary androgen deprivation therapy as monotherapy in unfavourable intermediate- and high-risk localised prostate cancer: a Singaporean single-centre perspective. Int Urol Nephrol 50:665–673
Kanar BG et al (2019) Androgen-deprivation therapy impairs left ventricle functions in prostate cancer patients. Int Urol Nephrol 51:1107–1112
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Supplementary material 1. Supplementary Table 1: Descriptive characteristics of 13,498 octogenarian non-metastatic prostate cancer patients within the Surveillance, Epidemiology and End Results (2004–2015) database, 1:1 propensity score matched and stratified according to treatment type (external beam radiation therapy [EBRT] vs. no local treatment [NLT]). (DOCX 14 kb)
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Knipper, S., Dzyuba-Negrean, C., Palumbo, C. et al. External beam radiation therapy improves survival in high- and intermediate-risk non-metastatic octogenarian prostate cancer patients. Int Urol Nephrol 52, 59–66 (2020). https://doi.org/10.1007/s11255-019-02284-1
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DOI: https://doi.org/10.1007/s11255-019-02284-1