Non-metastatic prostate cancer: rationale for conservative treatment and impact on disease-related morbidity and mortality in the elderly

Abstract

Purpose: To determine the rationale for not offering local treatment to prostate cancer patients with non-metastatic disease at diagnosis who later died of prostate cancer and to document local and systemic complications caused by disease progression. Material and Methods: In this population-based, retrospective study we reviewed the medical records of all patients who died of prostate cancer in 2009-2014 in Vestfold County (Vestfold Mortality Study), who were non-metastatic at diagnosis and who had received no local treatment to the prostate (n ¼ 117). Results: A review of patient records demonstrated that the chronological age of 75 years or older was the main rationale for not offering local treatment to the prostate (37%, n ¼ 43). No consideration was given to the functional status and patient health. These elderly patients stood for almost one-fifth of the total PC mortality in Vestfold County. In addition to dying from PC, 86% of patients developed local complications attributable to PC progression. Observation of strict limits for local treatment with regard to tumor characteristics contributed further to the underuse of local treatment. Conclusions: Our study demonstrated systematic undertreatment of elderly patients with aggressive, nonmetastatic PC with regard to local treatment based on chronological age alone. The patients in this study died of prostate cancer and the majority experienced significant morbidity caused by local tumor growth.

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

“…Similar to younger men, senior adults in the NoCurTrt group had a twofold increased risk of overall death within five years of diagnosis compared to patients treated curatively. The considerable 5‐year PCSM rates, along with the high proportion of patients having ISUP grade group ≥ 4 tumors and ECOG status ≤ 1 in the NoCurTrt group, suggest the likelihood of undertreatment, as also emphasized in other studies 27,4026 …”

“…Any life‐prolonging effect from CurTrt must in these patients be weighed against the risk of adverse treatment‐related effects and death from other causes than PCa 19‐21 . Studies have indicated that treatment decisions in PCa patients are primarily based on chronological age rather than biological age 7,22‐27 . Undertreatment of healthy senior adults with high‐risk PCa may thus contribute to the described high incidence of death from PCa in the elderly population 5,6,20,21 …”

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)

“…Older patients with cancer tend to perceive HRQoL as more important than improved survival compared to younger patients [20,21]. However, lack of tumour control could increase symptom burden and require surgical and medical interventions [2]; thus, immediate tumour‐directed treatment, could confer long‐term HRQoL benefits.…”

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

“…With the development and progress of modern medical technology, the cure rate of the disease is increasing, and most patients with prostate cancer will receive compound kushen injection for comprehensive endocrine treatment in order to control the number of tumor cells, improve clinical symptoms, enhance the quality of life, and prolongsurvival time. However, the psychological changes of patients are often ignored in practice, and adverse psychological emotions or inadequate family support will also have a negative impact on the treatment effect of patients, leading to unsatisfactory results of compound kushen injection [17][18][19][20]. With the advancement of medicine, more attention has been paid to the psychological recovery of patients, especially in elderly patients with prostate cancer.…”