The impact of age on clinicopathological features and treatment results in patients with localised prostate cancer receiving definitive radiotherapy
DOI:
https://doi.org/10.2340/1651-226X.2024.40759Keywords:
Age, prostate cancer, radiotherapy, survival, toxicityAbstract
Background: This study assessed the biochemical disease-free survival (bDFS), prostate cancer-specific survival (PCSS), overall survival (OS), and side effects in patients aged < 70 and ≥ 70 years following definitive radiotherapy (RT). It also analysed the correlation between age at diagnosis and clinicopathological characteristics of prostate cancer (PCa).
Methods: The prognostic factors for bDFS, PCSS, and OS were determined through univariable and multivariable analyses. Two age groups were also compared in terms of acute and late grade ≥ 2 genitourinary (GU) and gastrointestinal (GI) toxicities, the predictors of which were determined through logistic regression analysis.
Results: Of the 1,328 patients, 715 (53.8%) and 613 (46.2%) were aged < 70 and ≥ 70 years, respectively. Median follow-up time was 84.5 months. No significant differences in the 7-year bDFS (86.3% vs. 86.8%) and PCSS rates (92.9% vs. 93.3%) were found between the ≥ 70 and < 70 age groups. The multivariable analysis showed that advanced clinical T stage, high International Society of Urological Pathology (ISUP) grade, and high-risk disease independently predicted poor bDFS and PCSS. Metastatic lymph nodes were another bDFS prognostic factor. The multivariable analysis identified age ≥ 70 years, cardiac events at diagnosis, advanced stage, higher ISUP grade, and non-use of simultaneous integrated boost technique as negative factors for OS. Additionally, diabetes and transurethral resection of the prostate (TUR-P) independently predict late-grade ≥ 2 GU toxicity.
Interpretation: Definitive RT is a safe and effective treatment for patients with localised PCa no matter their age. Although patients over 70 years have higher risk factors and comorbidities, their bDFS, PCSS, and toxicities were comparable to those of patients aged < 70 years.
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Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.
https://doi.org/10.3322/caac.21660 DOI: https://doi.org/10.3322/caac.21660
Bergengren O, Pekala KR, Matsoukas K, Fainberg J, Mungovan SF, Bratt O, et al. 2022 update on prostate cancer epidemiology and risk factors – a systematic review. Eur Urol. 2023;84:191–206.
https://doi.org/10.1016/j.eururo.2023.04.021 DOI: https://doi.org/10.1016/j.eururo.2023.04.021
Bechis SK, Carroll PR, Cooperberg MR. Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol. 2011;29:235–41.
https://doi.org/10.1200/JCO.2010.30.2075 DOI: https://doi.org/10.1200/JCO.2010.30.2075
Pettersson A, Robinson D, Garmo H, Holmberg L, Stattin P. Age at diagnosis and prostate cancer treatment and prognosis: a population-based cohort study. Ann Oncol. 2018;29:377–85.
https://doi.org/10.1093/annonc/mdx742 DOI: https://doi.org/10.1093/annonc/mdx742
Shaheen H, Salans MA, Mohamad O, Coleman PW, Ahmed S, Roach M, 3rd. Age 70 +/- 5 years and cancer-specific outcomes after treatment of localized prostate cancer: a systematic review. Int J Radiat Oncol Biol Phys. 2024;118:672–81.
https://doi.org/10.1016/j.ijrobp.2023.09.018 DOI: https://doi.org/10.1016/j.ijrobp.2023.09.018
Roach M, 3rd, Bae K, Lawton C, Donnelly BJ, Grignon D, Hanks GE, et al. Baseline serum testosterone in men treated with androgen deprivation therapy and radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2010;78:1314–22.
https://doi.org/10.1016/j.ijrobp.2009.09.073 DOI: https://doi.org/10.1016/j.ijrobp.2009.09.073
Scher KS, Hurria A. Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Oncol. 2012;30:2036–8.
https://doi.org/10.1200/JCO.2012.41.6727 DOI: https://doi.org/10.1200/JCO.2012.41.6727
Keenan LG, O’Brien M, Ryan T, Dunne M, McArdle O. Assessment of older patients with cancer: Edmonton Frail Scale (EFS) as a predictor of adverse outcomes in older patients undergoing radiotherapy. J Geriatr Oncol. 2017;8:206–10.
https://doi.org/10.1016/j.jgo.2016.12.006 DOI: https://doi.org/10.1016/j.jgo.2016.12.006
Onal C, Erbay G, Guler OC, Yavas C, Oymak E. Treatment outcomes of simultaneous integrated boost to intraprostatic lesions with external beam radiotherapy in localized prostate cancer patients. Prostate. 2023;83:1158–66.
https://doi.org/10.1002/pros.24558 DOI: https://doi.org/10.1002/pros.24558
D’Amico AV, Whittington R, Schultz D, Malkowicz SB, Tomaszewski JE, Wein A. Outcome based staging for clinically localized adenocarcinoma of the prostate. J Urol. 1997;158:1422–6.
https://doi.org/10.1016/S0022-5347(01)64230-7 DOI: https://doi.org/10.1016/S0022-5347(01)64230-7
Onal C, Sonmez S, Erbay G, Guler OC, Arslan G. Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy. Br J Radiol. 2014;87(1034):20130617.
https://doi.org/10.1259/bjr.20130617 DOI: https://doi.org/10.1259/bjr.20130617
Roach M, 3rd, Hanks G, Thames H, Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006 15;65:965–74.
https://doi.org/10.1016/j.ijrobp.2006.04.029 DOI: https://doi.org/10.1016/j.ijrobp.2006.04.029
Bratt O, Folkvaljon Y, Hjälm Eriksson M, Akre O, Carlsson S, Drevin L, et al. Undertreatment of men in their seventies with high-risk nonmetastatic prostate cancer. Eur Urol. 2015;68:53–8.
https://doi.org/10.1016/j.eururo.2014.12.026 DOI: https://doi.org/10.1016/j.eururo.2014.12.026
Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol. 2011;59:88–95.
https://doi.org/10.1016/j.eururo.2010.10.003 DOI: https://doi.org/10.1016/j.eururo.2010.10.003
Wilson JM, Dearnaley DP, Syndikus I, Khoo V, Birtle A, Bloomfield D, et al. The efficacy and safety of conventional and hypofractionated high-dose radiation therapy for prostate cancer in an elderly population: A subgroup analysis of the CHHiP Trial. Int J Radiat Oncol Biol Phys. 2018;100:1179–89.
https://doi.org/10.1016/j.ijrobp.2018.01.016 DOI: https://doi.org/10.1016/j.ijrobp.2018.01.016
Maggio A, Panaia R, Garibaldi E, Bresciani S, Malinverni G, Stasi M, et al. Impact of age at diagnosis on overall and disease-free survival in men with prostate cancer following conformal 3D radiation therapy. Tumori. 2012;98:722–7.
https://doi.org/10.1177/030089161209800608 DOI: https://doi.org/10.1177/030089161209800608
Han JH, Herlemann A, Washington SL, Lonergan PE, Carroll PR, Cooperberg MR, et al. Observation, radiotherapy, or radical prostatectomy for localized prostate cancer: Survival analysis in the United States. World J Mens Health. 2023;41:940–50.
https://doi.org/10.5534/wjmh.220151 DOI: https://doi.org/10.5534/wjmh.220151
Kibel AS, Ciezki JP, Klein EA, Reddy CA, Lubahn JD, Haslag-Minoff J, et al. Survival among men with clinically localized prostate cancer treated with radical prostatectomy or radiation therapy in the prostate specific antigen era. J Urol. 2012;187:1259–65.
https://doi.org/10.1016/j.juro.2011.11.084 DOI: https://doi.org/10.1016/j.juro.2011.11.084
Keating NL, O’Malley A, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. J Natl Cancer Inst. 2012;104:1518–23.
D’Amico AV, Denham JW, Crook J, Chen MH, Goldhaber SZ, Lamb DS, et al. Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol. 2007;25:2420–5.
https://doi.org/10.1200/JCO.2006.09.3369 DOI: https://doi.org/10.1200/JCO.2006.09.3369
Voog JC, Paulus R, Shipley WU, Smith MR, McGowan DG, Jones CU, et al. Cardiovascular mortality following short-term androgen deprivation in clinically localized prostate cancer: An analysis of RTOG 94-08. Eur Urol. 2016;69:204–10.
https://doi.org/10.1016/j.eururo.2015.08.027 DOI: https://doi.org/10.1016/j.eururo.2015.08.027
Mason MD, Parulekar WR, Sydes MR, Brundage M, Kirkbride P, Gospodarowicz M, et al. Final report of the intergroup randomized study of combined androgen-deprivation therapy plus radiotherapy versus androgen-deprivation therapy alone in locally advanced prostate cancer. J Clin Oncol. 2015;33:2143–50.
https://doi.org/10.1200/JCO.2014.57.7510 DOI: https://doi.org/10.1200/JCO.2014.57.7510
Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol. 2010;11:1066–73.
https://doi.org/10.1016/S1470-2045(10)70223-0 DOI: https://doi.org/10.1016/S1470-2045(10)70223-0
Löffeler S, Bertilsson H, Müller C, Aas K, Haugnes HS, Aksnessæther B, et al. Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged ≥ 75 years with non-metastatic high-risk prostate cancer (SPCG 19/GRand-P). BJU Int. 2024;133:680–9.
https://doi.org/10.1111/bju.16314 DOI: https://doi.org/10.1111/bju.16314
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