Long-term prostate cancer survival outcomes including patterns of death in men >=75 years of age treated with low dose rate brachytherapy.

backgroundPotentially curative therapeutic interventions in elderly men with prostate cancer remain controversial due to the presence of concomitant medical comorbidities and concerns of over-treatment and poor tolerance. The purpose of this study is to evaluate long-term outcomes and explore whether comorbidities at presentation may serve to guide patient selection.

methods268 consecutive men > = 75 years underwent LDR brachytherapy (BT). Post-implant dosimetry was based on day 0 CT evaluation. EBRT & ADT were delivered to 63.1% & 41.0%, respectively. Biochemical failure (BF) was defined as a PSA > 0.40ng/ml after nadir. Patients with metastatic prostate cancer or non-metastatic castrate resistant disease who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple parameters were evaluated for impact on survival.

resultsThe median patient age was 76.0 years with 67.9% presenting with unfavorable intermediate (UIR) or high risk (HR) disease. The median follow-up was 8.8 years. At presentation, 35.6% presented with 0-1 comorbidities, 24.9% had mid-high normal serum testosterone & 38.4% were never smokers. Overall,10-year BF, prostate cancer specific mortality (PCSM) & overall mortality (OM) were 4.2%, 0.8% & 44.8%. The median post-treatment PSA in biochemically controlled patients was < 0.01ng/ml. 190 patients died with 2 (1.1%) dead of prostate cancer. Death from cardiovascular disease (44.2%) & non-prostate cancer deaths (23.1%) predominated. In Fine-Gray analysis, OM was best predicted by the number of comorbidities with the strongest relationship in those with > = 3 comorbidities (HR 3.36, p < 0.001). No patient required therapeutic intervention for hematuria or hematochezia or developed a rectal fistula. 2 patients developed urinary incontinence.

conclusionsDefinitive treatment is warranted in appropriately selected elderly men with clinically localized prostate cancer. Patient selection criteria to include the number of comorbidities must be assessed to maximize oncologic outcomes and minimize over-treatment. Men with clinically higher risk prostate cancer and no comorbidities are most likely to benefit from definitive treatment regimens.