How to choose proper local treatment in men aged ≥75 years with cT2 localized prostate cancer?

Abstract

Background For localized prostate cancer (PCa), radical prostatectomy (RP) and radiotherapy (RT) are two standard interventions to decrease PCa mortality. Contemporary studies contained the elderly people; analyses focusing on patients over 75 years of age were still lacking. Method In the Surveillance Epidemiology and End Results (SEER) database (2004‐2015), people over 75 years of age with cT2 stage were selected in our research. Multivariable Cox proportional hazard models were used to analyze cancer‐specific mortality (CSM) and overall mortality (OM) after adjustment. The propensity score matching was performed to assume the randomization. An instrument variate (IVA) was used to calculate the unmeasured confounders. Results Radical prostatectomy is superior to RT in OM and CSM after adjustment for covariates (HR = 0.54, 95% CI = 0.47‐0.62, P < 0.001 and HR = 0.30, 95% CI = 0.20‐0.45, P < 0.001, respectively). The cox model after matching indicated similar consequence (OM: HR = 0.53, 95% CI = 0.46‐0.62, P < 0.001; CSM: HR = 0.27, 95% CI = 0.17‐0.43, P < 0.001). In the IVA‐adjusted model, the effect of treatment changed slightly (OM: HR = 0.65, 95% CI = 0.54‐0.78, P < 0.001; CSM: HR = 0.21, 95% CI = 0.12‐0.37, P < 0.001). Subgroup analyses showed that for patients with GS = 7, those received RP obtained the highest risk decline for overall death (HR = 0.41, 95% CI = 0.32‐0.52); and for patients with younger age, those received RP obtained the highest risk decline for CSM (HR = 0.11, 95% CI = 0.01‐0.52). Conclusion Patients over 75 years of age with cT2 stage will obtain more benefit from RP compared with RT, especially for patients with GS = 7 and younger age.

Effect of Psychological Intervention Combined with Family Cooperation on the Perioperative Quality of Life and Psychological States of Elderly Patients with Prostate Cancer Treated with Compound Kushen Injection

“…Because the treatment method mainly targets the patients' special parts through the urinary system surgery, patients are prone to greater psychological burdens. erefore, a scientific psychological intervention mode is more conducive to the postoperative rehabilitation of patients [21][22][23][24].…”

Surgical Tolerability and Frailty in Elderly Patients Undergoing Robot-Assisted Radical Prostatectomy: A Narrative Review

“…Unfortunately, there are no RCTs evaluating the comparison of treatments in an elderly population. Notably, one large retrospective study including 10,563 men aged ≥75 years with cT2 localized PCa showed that RP was superior to RT in overall survival and cancer-specific survival after propensity score matching (hazard ratio (HR) = 0.54, 95% confidence interval (CI) = 0.47–0.62, and HR = 0.30, 95% CI = 0.20–0.45) [ 25 ]. Interestingly, a sub-analysis in the study showed that for patients with Gleason score (GS) = 7, RP provided a higher risk decline of overall death when compared with RT treatment [ 25 ].…”