Mike Wenzel1,2, Christoph Würnschimmel2,3, Francesco Chierigo2,4, Zhe Tian2, Shahrokh F Shariat5,6,7,8,9,10, Carlo Terrone4, Fred Saad2, Derya Tilki3,11, Markus Graefen3, Philipp Mandel1, Luis A Kluth1, Felix K H Chun1, Pierre I Karakiewicz2. 1. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. 2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. 3. Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy. 5. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 6. Departments of Urology, Weill Cornell Medical College, New York, New York, USA. 7. Department of Urology, University of Texas Southwestern, Dallas, Texas, USA. 8. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic. 9. Department of Urology, Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 10. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 11. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: To test for rates of other cause mortality (OCM) and cancer-specific mortality (CSM) in elderly prostate cancer (PCa) patients treated with the combination of radical prostatectomy (RP) and external beam radiation therapy (EBRT) versus RP alone, since elderly PCa patients may be over-treated. METHODS: Within the Surveillance, Epidemiology and End Results database (2004-2016), cumulative incidence plots, after propensity score matching for cT-stage, cN-stage, prostate specific antigen, age and biopsy Gleason score, and multivariable competing risks regression models (socioeconomic status, pathological Gleason score) addressed OCM and CSM in patients (70-79, 70-74, and 75-79 years) treated with RP and EBRT versus RP alone. RESULTS: Of 18,126 eligible patients aged 70-79 years, 2520 (13.9%) underwent RP and EBRT versus 15,606 (86.1%) RP alone. After propensity score matching, 10-year OCM rates were respectively 27.9 versus 20.3% for RP and EBRT versus RP alone (p < .001), which resulted in a multivariable HR of 1.4 (p < .001). Moreover, 10-year CSM rates were respectively 13.4 versus 5.5% for RP and EBRT versus RP alone. In subgroup analyses separately addressing 70-74 year old and 75-79 years old PCa patients, 10-year OCM rates were 22.8 versus 16.2% and 39.5 versus 24.0% for respectively RP and EBRT versus RP alone patients (all p < .001). CONCLUSION: Elderly patients treated with RP and EBRT exhibited worrisome rates of OCM. These higher than expected OCM rates question the need for combination therapy (RP and EBRT) in elderly PCa patients and indicate the need for better patient selection, when combination therapy is contemplated.
BACKGROUND: To test for rates of other cause mortality (OCM) and cancer-specific mortality (CSM) in elderly prostate cancer (PCa) patients treated with the combination of radical prostatectomy (RP) and external beam radiation therapy (EBRT) versus RP alone, since elderly PCa patients may be over-treated. METHODS: Within the Surveillance, Epidemiology and End Results database (2004-2016), cumulative incidence plots, after propensity score matching for cT-stage, cN-stage, prostate specific antigen, age and biopsy Gleason score, and multivariable competing risks regression models (socioeconomic status, pathological Gleason score) addressed OCM and CSM in patients (70-79, 70-74, and 75-79 years) treated with RP and EBRT versus RP alone. RESULTS: Of 18,126 eligible patients aged 70-79 years, 2520 (13.9%) underwent RP and EBRT versus 15,606 (86.1%) RP alone. After propensity score matching, 10-year OCM rates were respectively 27.9 versus 20.3% for RP and EBRT versus RP alone (p < .001), which resulted in a multivariable HR of 1.4 (p < .001). Moreover, 10-year CSM rates were respectively 13.4 versus 5.5% for RP and EBRT versus RP alone. In subgroup analyses separately addressing 70-74 year old and 75-79 years old PCa patients, 10-year OCM rates were 22.8 versus 16.2% and 39.5 versus 24.0% for respectively RP and EBRT versus RP alone patients (all p < .001). CONCLUSION: Elderly patients treated with RP and EBRT exhibited worrisome rates of OCM. These higher than expected OCM rates question the need for combination therapy (RP and EBRT) in elderly PCa patients and indicate the need for better patient selection, when combination therapy is contemplated.
Authors: Christoph Würnschimmel; Mike Wenzel; Francesco Chierigo; Rocco Simone Flammia; Benedikt Horlemann; Zhe Tian; Fred Saad; Alberto Briganti; Sharokh F Shariat; Michele Gallucci; Nazareno Suardi; Felix K H Chun; Derya Tilki; Markus Graefen; Pierre I Karakiewicz Journal: Cancer Causes Control Date: 2022-03-01 Impact factor: 2.532
Authors: Mike Wenzel; Luigi Nocera; Christoph Würnschimmel; Claudia Collà Ruvolo; Zhe Tian; Fred Saad; Alberto Briganti; Derya Tilki; Markus Graefen; Andreas Becker; Frederik C Roos; Felix K H Chun; Pierre I Karakiewicz Journal: Front Oncol Date: 2021-10-06 Impact factor: 6.244