Poor overall survival in septa- and octogenarian patients after radical prostatectomy and radiotherapy for prostate cancer: a population-based study of 6183 men.
Academic Article
Overview
abstract
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.
