OBJECTIVES: The life expectancy of candidates for attempted curative therapy of prostate cancer should not be inferior to 10 yr. We examined the rate of 10-yr survival in septa- and octogenarians treated for prostate cancer with either attempted curative external beam radiotherapy (EBRT) or radical prostatectomy (RP). METHODS: Within a population-based cohort of 17,570 EBRT or RP patients, 6183 men aged 70 yr or older were treated with either RP (n=1591) or EBRT (n=4592) and represented the focus of crude survival analyses. Age and Charlson Comorbidity Index represented covariates. To control for prostate cancer-specific mortality, we repeated the analyses in a subset of 2704 men (RP, n=881; EBRT, n=1823) who had no clinical evidence of disease relapse of prostate cancer. RESULTS: Overall actuarial 10-yr survival was 38.5% (RP 59.3% vs. EBRT 30.3%, p<0.001) versus 36.5% in those without clinical evidence of disease relapse (RP 63.8% vs. EBRT 22.6%, p<0.001). In multivariate Cox regression models, EBRT was associated with a 2.1-fold (p<0.001) and 2.9-fold (p<0.001) higher risk of mortality relative to RP in all men and in men without clinical evidence of disease relapse, respectively. CONCLUSIONS: Forty percent of septa- and octogenarian men who are selected for RP do not have adequate life expectancy to warrant attempted curative therapy. Even more strikingly, 70% of men who receive EBRT die before reaching the 10-yr mark. These findings may indicate the need for more stringent EBRT and RP selection criteria, if the goal is to minimise overtreatment.
OBJECTIVES: The life expectancy of candidates for attempted curative therapy of prostate cancer should not be inferior to 10 yr. We examined the rate of 10-yr survival in septa- and octogenarians treated for prostate cancer with either attempted curative external beam radiotherapy (EBRT) or radical prostatectomy (RP). METHODS: Within a population-based cohort of 17,570 EBRT or RP patients, 6183 men aged 70 yr or older were treated with either RP (n=1591) or EBRT (n=4592) and represented the focus of crude survival analyses. Age and Charlson Comorbidity Index represented covariates. To control for prostate cancer-specific mortality, we repeated the analyses in a subset of 2704 men (RP, n=881; EBRT, n=1823) who had no clinical evidence of disease relapse of prostate cancer. RESULTS: Overall actuarial 10-yr survival was 38.5% (RP 59.3% vs. EBRT 30.3%, p<0.001) versus 36.5% in those without clinical evidence of disease relapse (RP 63.8% vs. EBRT 22.6%, p<0.001). In multivariate Cox regression models, EBRT was associated with a 2.1-fold (p<0.001) and 2.9-fold (p<0.001) higher risk of mortality relative to RP in all men and in men without clinical evidence of disease relapse, respectively. CONCLUSIONS: Forty percent of septa- and octogenarian men who are selected for RP do not have adequate life expectancy to warrant attempted curative therapy. Even more strikingly, 70% of men who receive EBRT die before reaching the 10-yr mark. These findings may indicate the need for more stringent EBRT and RP selection criteria, if the goal is to minimise overtreatment.
Authors: Räto T Strebel; Tullio Sulser; Hans-Peter Schmid; Silke Gillessen; Martin Fehr; Urs Huber; Miklos Pless; Rudolf Morant; Ralph Winterhalder; Richard Cathomas Journal: Support Care Cancer Date: 2013-03-26 Impact factor: 3.603
Authors: Jae Won Park; Dong Hoon Koh; Won Sik Jang; Joo Yong Lee; Kang Su Cho; Won Sik Ham; Koon Ho Rha; Woo Hee Jung; Sung Joon Hong; Young Deuk Choi Journal: PLoS One Date: 2018-06-20 Impact factor: 3.240
Authors: Lauren J Beesley; Todd M Morgan; Daniel E Spratt; Udit Singhal; Felix Y Feng; Allison Cullen Furgal; William C Jackson; Stephanie Daignault; Jeremy M G Taylor Journal: JAMA Netw Open Date: 2019-02-01