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External beam radiation therapy improves survival in high- and intermediate-risk non-metastatic octogenarian prostate cancer patients

  • Sophie KnipperEmail author
  • Cristina Dzyuba-Negrean
  • Carlotta Palumbo
  • Angela Pecoraro
  • Giuseppe Rosiello
  • Zhe Tian
  • Alberto Briganti
  • Fred Saad
  • Derya Tilki
  • Markus Graefen
  • Pierre I. Karakiewicz
Urology - Original Paper
  • 64 Downloads

Abstract

Purpose

There is no contemporary proof of cancer-control benefits in octogenarian clinically localized prostate cancer (PCa) patients with life expectancy (LE) < 10 years. Therefore, cancer-specific mortality (CSM) rates after external beam radiation therapy (EBRT) vs. no local treatment (NLT) were tested in octogenarian PCa patients with LE < 10 years.

Methods

Within the surveillance, epidemiology, and end results database (2004–2015), we identified 22,361 octogenarian clinically localized PCa patients who either received EBRT or NLT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses (MCR) were used after propensity score matching. Sensitivity analyses were performed according to D’Amico risk groups and LE > 5 years.

Results

Of all, 7325 (32.8%) received EBRT vs. 15,036 (67.2%) received NLT. Rates of EBRT significantly increased over time (25.0–42.4%). Overall, 10-year CSM rates were 10.6% vs. 17.0% and 10-year other-cause mortality rates were 50.3% vs. 58.1%, in EBRT vs. NLT patients (both p < 0.001). In MCR focusing on the overall cohort, EBRT represented an independent predictor of lower CSM (hazard ratio: 0.5). In sensitivity analyses, hazard ratios of 0.5 (p < 0.001), 0.5 (p < 0.001) and 0.8 (p = 0.5) were, respectively, recorded in D’Amico high-, intermediate- and low-risk patients. In sensitivity analyses addressing patients with LE > 5 years virtually the same results were recorded.

Conclusions

In octogenarian patients with LE < 10 years, EBRT seems to be associated with lower CSM in D’Amico high-risk, as well as in D’Amico intermediate-risk patients relative to their NLT counterparts. Based on these observations, greater consideration for EBRT may be given in octogenarian patients.

Keywords

Life expectancy Local treatment Cancer-specific mortality SEER D’Amico risk groups 

Notes

Acknowledgements

There was no external financial support for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11255_2019_2284_MOESM1_ESM.docx (14 kb)
Supplementary material 1. Supplementary Table 1: Descriptive characteristics of 13,498 octogenarian non-metastatic prostate cancer patients within the Surveillance, Epidemiology and End Results (2004–2015) database, 1:1 propensity score matched and stratified according to treatment type (external beam radiation therapy [EBRT] vs. no local treatment [NLT]). (DOCX 14 kb)

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Sophie Knipper
    • 1
    • 2
    Email author
  • Cristina Dzyuba-Negrean
    • 2
  • Carlotta Palumbo
    • 2
    • 3
  • Angela Pecoraro
    • 2
    • 4
  • Giuseppe Rosiello
    • 2
    • 5
  • Zhe Tian
    • 2
  • Alberto Briganti
    • 5
  • Fred Saad
    • 2
  • Derya Tilki
    • 1
    • 6
  • Markus Graefen
    • 1
  • Pierre I. Karakiewicz
    • 2
  1. 1.Martini-Klinik Prostate Cancer CenterUniversity Hospital Hamburg-EppendorfHamburgGermany
  2. 2.Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montreal Health CenterMontrealCanada
  3. 3.Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public HealthUniversity of BresciaBresciaItaly
  4. 4.Department of Urology, San Luigi Gonzaga HospitalUniversity of TurinTurinItaly
  5. 5.Department of Urology and Division of Experimental Oncology, URI, Urological Research InstituteIRCCS San Raffaele Scientific InstituteMilanItaly
  6. 6.Department of UrologyUniversity Hospital Hamburg-EppendorfHamburgGermany

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