Increased curative treatment is associated with decreased prostate cancer‐specific and overall mortality in senior adults with high‐risk prostate cancer; results from a national registry‐based cohort study

Abstract

Background The association between curative treatment (CurTrt) and mortality in senior adults (≥70 years) with high‐risk prostate cancer (PCa) is poorly documented. In a population‐based cohort we report temporal trends in treatment and PCa‐specific mortality (PCSM), investigating the association between CurTrt and mortality in senior adults with high‐risk PCa, compared to findings in younger men (<70 years). Methods Observational study from the Cancer Registry of Norway. Patients with high‐risk PCa were stratified for three diagnostic periods (2005‐08, 2009‐12 and 2013‐16), age (<70, vs ≥70) and primary treatment (CurTrt: Radical prostatectomy (RP), Radiotherapy (RAD) vs no curative treatment (NoCurTrt)). Competing risk and Kaplan‐Meier methods estimated PCSM and overall mortality (OM), respectively. Multivariable logistic regression models estimated odds for CurTrt, and multivariable Fine Gray and Cox regression models evaluated the hazard ratios for PCSM and OM. Results Of 19 763 evaluable patients, 54% were aged ≥70 years. Senior adults had more unfavorable PCa characteristics than younger men. Across diagnostic periods, use of CurTrt increased from 15% to 51% in men aged ≥70 and 65% to 81% in men aged < 70 years. With median five years follow‐up, PCSM decreased in all patients (P < .05), in the third period restricted to senior adults. In all patients NoCurTrt was associated with three‐fold higher 5‐year PCSM and two‐fold higher OM compared to CurTrt. Conclusions In high‐risk PCa patients, increased use of CurTrt, greatest in senior men, was observed along with decreased PCSM and OM in both senior and younger adults. CurTrt should increasingly be considered in men ≥70 years.

The Dilemma of Misclassification Rates in Senior Patients With Prostate Cancer, Who Were Treated With Robot-Assisted Radical Prostatectomy: Implications for Patient Counseling and Diagnostics

“…Specifically, our results demonstrated that senior age is not inherently a risk factor for unfavorable prognosis and that sufficient functional outcomes can be achieved that are highly comparable to younger patients, such as urinary continence recovery. Thus, we contributed to a paradigm shift that selects senior patients who can be in fact counseled for local therapies, such as RARP (3,4). However, consistent with several studies developing prediction tools for upgrading and upstaging, when biopsy vs. final histopathology was compared, senior age appeared indeed to have more unfavorable pathology and our own observations indicated greater misclassification between clinical vs. pathological stages.…”

“…However, based on a rather stringent concept of 10 years life expectancy, which is mostly based on national demographic estimates and in compliance with present guidelines, many patients are precluded from local treatment, when such a patient is being consulted for treatment. This is despite recent series, which demonstrated that senior patients, who are treated with RARP, might experience low perioperative morbidity, achieve excellent results of cancer control, quality of life (QoL), and functional results (4,13,17,18). Conversely, it is of utmost importance to consider watchful waiting strategies or active surveillance after carefully weighing risk and benefit and QoL (19).…”

“…Our series was one of the first to demonstrate that senior age is not a contraindication for local treatment, such as robot-assisted radical prostatectomy (RARP) ( 3 , 4 ). Specifically, our results demonstrated that senior age is not inherently a risk factor for unfavorable prognosis and that sufficient functional outcomes can be achieved that are highly comparable to younger patients, such as urinary continence recovery.…”

“…Specifically, our results demonstrated that senior age is not inherently a risk factor for unfavorable prognosis and that sufficient functional outcomes can be achieved that are highly comparable to younger patients, such as urinary continence recovery. Thus, we contributed to a paradigm shift that selects senior patients who can be in fact counseled for local therapies, such as RARP ( 3 , 4 ).…”

Irradiation of localized prostate cancer in the elderly: A systematic literature review

“…Fortunately, in recent years, we report an increase in local treatment in older adults with a positive impact on specific mortality. As recently described by Aas et al, curative treatment in high-risk patients over 70 has increased almost 6-fold (15 to 51%) in 10 years with a parallel decrease in specific mortality [21] . The absence of curative treatment unequivocally increased specific mortality by a factor of 3 and also overall mortality by a factor of 2 [21] .…”