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World Journal of Urology

, Volume 37, Issue 2, pp 317–325 | Cite as

Elderly patients aged ≥ 75 years with locally advanced prostate cancer may benefit from local treatment: a population-based propensity score-adjusted analysis

  • Wei ShengEmail author
  • Ruth Kirschner-Hermanns
  • Hongwei Zhang
Original Article
  • 103 Downloads

Abstract

Objective

To evaluate whether elderly patients aged ≥ 75 years with locally advanced prostate cancer (LAPC) may benefit from local treatment (LT).

Methods

Elderly patients aged ≥ 75 years with non-metastatic cT3–4 LAPC who were treated with LT [radical prostatectomy (RP), radiation therapy (RT)] or non-LT (NLT) were identified. After propensity score matching (PSM), cancer-specific mortality (CSM) and other-cause mortality (OCM) rates were assessed. In the assessment of LT vs. NLT and RP vs. RT, multivariable competing risk regression (MVA CRR) analysis was used.

Results

368 and 482 paired patients were matched for LT vs. NLT and RP vs. RT, respectively. 5 and 10 years CSM rates were 9.4 vs. 18.5% in LT and 24.9 vs. 29.3% in NLT-treated patients, respectively (P < 0.0001). 5 and 10 years CSM rates were 3.4% vs. 8.6% in RP and 6.7% vs. 15.1% in RT-treated patients, respectively (P = 0.10). In the MVA CRR model, after PSM, NLT resulted in higher CSM rates in Gleason score 8–10 [subhazard ratio (sHR) = 2.83, P < 0.001], cT3b/4 (sHR = 3.97/2.56, P = 0.003/0.002), cN0 (sHR = 2.52, P < 0.001) or PSA > 10 ng/ml [sHR (PSA = 10.1–20 ng/ml) = 4.59, P = 0.03; sHR (PSA > 20 ng/ml) = 2.77, P = 0.001] patients compared with LT. However, no statistically significant difference in CSM was observed between RP and RT, except for cT3a patients in whom higher CSM rates were noted for RT compared with RP (sHR = 3.91, P = 0.02).

Conclusion

LAPC patients may benefit from local treatment despite advanced age. However, this benefit was only seen in patients with cT3b/4, Gleason score 8–10, cN0 or PSA > 10 ng/ml.

Keywords

Elderly patients Aged ≥ 75 years Locally advanced prostate cancer Cancer-specific mortality Propensity score matching Local treatment 

Notes

Acknowledgements

Wei Sheng is grateful for the funding from the China Scholarship Council (201608080204).

Author contributions

Protocol/project development: WS, HWZ; data collection or management: WS; manuscript writing/editing: WS, RK.

Compliance with ethical standards

Conflict of interest

All authors have no actual or potential conflict of interest.

Supplementary material

345_2018_2389_MOESM1_ESM.tif (571 kb)
Supplementary Fig. 1. Patient selection and exclusion process (TIFF 571 kb)
345_2018_2389_MOESM2_ESM.tif (715 kb)
Supplementary Fig. 2. The jitter plot for local treatment vs. non-local treatment in propensity score matching (TIFF 714 kb)
345_2018_2389_MOESM3_ESM.tif (819 kb)
Supplementary Fig. 3. The jitter plot for radical prostatectomy vs. radiation therapy in propensity score matching (TIFF 819 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology/Neuro-Urology, University ClinicUniversity of BonnBonnGermany
  2. 2.The First People’s Hospital of Changde CityChangdeChina

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