Non-cancer mortality in elderly prostate cancer patients treated with combination of radical prostatectomy and external beam radiation therapy
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Non-cancer mortality in elderly prostate cancer patients treated with combination of radical prostatectomy and external beam radiation therapy. / Wenzel, Mike; Würnschimmel, Christoph; Chierigo, Francesco; Tian, Zhe; Shariat, Shahrokh F; Terrone, Carlo; Saad, Fred; Tilki, Derya; Graefen, Markus; Mandel, Philipp; Kluth, Luis A; Chun, Felix K H; Karakiewicz, Pierre I.
in: PROSTATE, Jahrgang 81, Nr. 11, 08.2021, S. 728-735.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Non-cancer mortality in elderly prostate cancer patients treated with combination of radical prostatectomy and external beam radiation therapy
AU - Wenzel, Mike
AU - Würnschimmel, Christoph
AU - Chierigo, Francesco
AU - Tian, Zhe
AU - Shariat, Shahrokh F
AU - Terrone, Carlo
AU - Saad, Fred
AU - Tilki, Derya
AU - Graefen, Markus
AU - Mandel, Philipp
AU - Kluth, Luis A
AU - Chun, Felix K H
AU - Karakiewicz, Pierre I
N1 - © 2021 The Authors. The Prostate published by Wiley Periodicals LLC.
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
U2 - 10.1002/pros.24169
DO - 10.1002/pros.24169
M3 - SCORING: Journal article
C2 - 34010465
VL - 81
SP - 728
EP - 735
JO - PROSTATE
JF - PROSTATE
SN - 0270-4137
IS - 11
ER -
