Roger Valdivieso1,2, Katharina Boehm3,4, Malek Meskawi1,2, Alessandro Larcher1,5, Zhe Tian1, Marie-Elise Parent6,7, Philip Wong8, Markus Graefen9, Francesco Montorsi5, Maxine Sun1, Fred Saad2, Pierre I Karakiewicz1,2. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. 2. Department of Urology, University of Montreal Health Center, Montreal, QC, Canada. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. boehm@martini-klinik.de. 4. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. boehm@martini-klinik.de. 5. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 6. INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique, Laval, QC, Canada. 7. University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada. 8. Department of Radiation Oncology, University of Montreal Health Center, Montreal, QC, Canada. 9. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
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.
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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