Abstract
Introduction
Elderly men are underrepresented in prostate cancer (PCa) literature, with management
based on individualized care pathways and life expectancy. Reports have shown survival
benefit with radiation (XRT), surgery, and hormone (ADT) in localized disease. The
objective of this study was to assess treatment trends and overall survival (OS) among
men 75 years of age and older with cT1c PCa.
Methods
The National Cancer Database was queried to identify patients with cT1c PCa, aged
75 years and older, between 2004 and 2016. We excluded individuals with N1/NX or M1/MX
disease, unknown treatment, treatment with both XRT and surgery, surgery other than
radical prostatectomy (RP), or PSA > 10 ng/ml. We described 4 treatment cohorts: observation,
XRT, surgery, and ADT alone. Treatment trends and OS were analyzed using SPSS.
Results
Among 49,843 patients, 7% had surgery, 66% had XRT, 5% had ADT alone, and 22% were
observed. From 2004-2016, a large decline in XRT was noted, with an increase in surgery
and observation. Men receiving ADT alone were significantly older, with higher Gleason's
score, and lower incomes. Cox regression revealed survival benefit for surgery and
XRT (HR 0.44 and 0.69, P < .001 respectively); ADT had worse survival than observation (HR 1.23, P < .001).
Conclusion
Fewer men 75 years of age and older with cT1c PCa are being diagnosed and treated.
Rates of XRT have declined, with rises in surgery and observation. Survival benefit
was seen for surgery and XRT among elderly men, which highlights the importance of
proper patient selection for improved outcomes in a highly individualized sphere.
Keywords
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Article info
Publication history
Published online: October 12, 2022
Accepted:
October 4,
2022
Received in revised form:
October 3,
2022
Received:
August 28,
2022
Identification
Copyright
Published by Elsevier Inc.
