Prostate cancer: a comparison of treatment modalities in high-risk elders

  • Urologic Oncology.

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In elderly patients with high-risk prostate cancer, 10-year OS significantly improved with external beam radiation therapy (EBRT) + brachytherapy ± androgen deprivation therapy (ADT) vs radical prostatectomy (RP), but not with ADT+EBRT.
  • EBRT+ADT was associated with worse 10-year cancer-specific mortality.
  • Cost was higher in EBRT groups.

Why this matters

  • Long-term outcomes and cost of treatment modalities in older patients are not clear.

Study design

  • 6296 patients with high-risk prostate cancer (age, ≥66 years) from Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1996 and 2003.
  • Patients received either RP, EBRT+ADT, or EBRT+brachytherapy with or without ADT.
  • Funding: Agency for Healthcare and Research Quality.

Key results

  • Compared with RP alone, 10-year OS:
    • significantly improved with EBRT+brachytherapy±ADT (aHR, 0.47; 95% CI, 0.31-0.73).
    • was similar with EBRT+ADT (aHR, 1.09; 95% CI, 0.72-1.66).
  • ADT+EBRT group showed significantly worse 10-year cancer-specific survival vs RP (aHR, 2.19; 95% CI, 1.92-5.21).
  • Treatment cost was significantly higher with EBRT+ADT (aOR, 1.72; 95% CI, 1.35-2.20) and EBRT+brachytherapy±ADT (aOR, 1.63; 95% CI, 1.29-2.04).
  • Gastrointestinal and genitourinary complications were higher with EBRT+brachytherapy±ADT during follow-up.

Limitations

  • Retrospective design.

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