Elderly patients aged ≥ 75 years with locally advanced prostate cancer may benefit from local treatment: a population-based propensity score-adjusted analysis
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To evaluate whether elderly patients aged ≥ 75 years with locally advanced prostate cancer (LAPC) may benefit from local treatment (LT).
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.
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).
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.
KeywordsElderly patients Aged ≥ 75 years Locally advanced prostate cancer Cancer-specific mortality Propensity score matching Local treatment
Wei Sheng is grateful for the funding from the China Scholarship Council (201608080204).
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.
- 5.Moltzahn F, Karnes J, Gontero P et al (2015) Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk cT3b/4 PCa: a multi-institutional outcome study of 266 patients. Prostate Cancer Prostatic Dis 18(1):31–37. https://doi.org/10.1038/pcan.2014.41 CrossRefGoogle Scholar
- 8.National Cancer Institute Surveillance, Epidemiology, and EndResults Prostate-Specific Antigen Working Group, Adamo MP, Boten JA et al (2017) Validation of prostate-specific antigen laboratory values recorded in surveillance, epidemiology, and end results registries. Cancer 123:697–703. https://doi.org/10.1002/cncr.30401 CrossRefGoogle Scholar
- 10.D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281. https://doi.org/10.1002/(sici)1097-0258(19981015)17:19<2265::aid-sim918>3.0.co;2-bGoogle Scholar
- 11.Gray R (1988) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 6:1140–1154. http://www.jstor.org/stable/2241622
- 18.Cheng L1, Zincke H, Blute ML et al (2001) Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer 91(1):66–73. https://doi.org/10.1002/1097-0142(20010101)91:1<66::AID-CNCR9>3.0.CO;2-PGoogle Scholar