Survival rates with external beam rad... - Advanced Prostate...

Advanced Prostate Cancer

13,940 members17,068 posts

Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients

pjoshea13 profile image

New German study below [1].

The elderly patients were at least 75 at diagnosis.

Only 2 more years & I will finally be elderly. I wonder what it will be like? LOL. As a group, older guys obviously have shorter life expectancy, but there has to be a better way to define 'elderly' than age. What about comorbidities & shouldn't there be some credit for those who run 10 miles before breakfast, etc?

"Of 6556 patients, 1105 received EBRT (16.9%). M1b stage was predominant in both EBRT (n = 823; 74.5%) and no EBRT (n = 3908; 71.7% ...) groups, followed by M1c (n = 211; 19.1% vs. n = 1042; 19.1%, ...) and M1a (n = 29; 2.6% vs. n = 268; 4.9%, ...).

"Median overall survival (OS) was 23 months for EBRT and 23 months for no EBRT (hazard ratio [HR] ...).

"Similarly, median cancer-specific survival (CSS) was 29 months for EBRT versus 30 months for no EBRT (HR: 1.04 ...).

"After additional multivariable adjustment, EBRT was not associated with lower {overall mortality} or lower {cancer-specific mortality} in the entire cohort, as well as after stratification for M1b and M1c substages."

"... our findings question the added value of local EBRT in elderly newly diagnosed mPCa patients."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/346...

Prostate

. 2021 Oct 11. doi: 10.1002/pros.24249. Online ahead of print.

Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients

Mike Wenzel 1 2 , Claudia Collà Ruvolo 2 3 , Christoph Würnschimmel 2 4 , Luigi Nocera 2 5 , Zhe Tian 2 , Fred Saad 2 , Alberto Briganti 3 , Derya Tilki 4 6 , Markus Graefen 4 , Andreas Becker 1 , Frederik Roos 1 , Philipp Mandel 1 , Felix K H Chun 1 , Pierre I Karakiewicz 2

Affiliations collapse

Affiliations

1 Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.

2 Division of Urology, Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

3 Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples Federico II, Naples, Italy.

4 Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

5 Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.

6 Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

PMID: 34633102 DOI: 10.1002/pros.24249

Abstract

Background: The survival benefit of primary external beam radiation therapy (EBRT) has never been formally tested in elderly men who were newly diagnosed with metastatic prostate cancer (mPCa). We hypothesized that elderly patients may not benefit of EBRT to the extent as younger newly diagnosed mPCa patients, due to shorter life expectancy.

Methods: We relied on Surveillance, Epidemiology and End Results (2004-2016) to identify elderly newly diagnosed mPCa patients, aged >75 years. Kaplan-Meier, univariable and multivariable Cox regression models, as well as Competing Risks Regression models tested the effect of EBRT versus no EBRT on overall mortality (OM) and cancer-specific mortality (CSM).

Results: Of 6556 patients, 1105 received EBRT (16.9%). M1b stage was predominant in both EBRT (n = 823; 74.5%) and no EBRT (n = 3908; 71.7%, p = 0.06) groups, followed by M1c (n = 211; 19.1% vs. n = 1042; 19.1%, p = 1) and M1a (n = 29; 2.6% vs. n = 268; 4.9%, p < 0.01). Median overall survival (OS) was 23 months for EBRT and 23 months for no EBRT (hazard ratio [HR]: 0.97, p = 0.6). Similarly, median cancer-specific survival (CSS) was 29 months for EBRT versus 30 months for no EBRT (HR: 1.04, p = 0.4). After additional multivariable adjustment, EBRT was not associated with lower OM or lower CSM in the entire cohort, as well as after stratification for M1b and M1c substages.

Conclusions: In elderly men who were newly diagnosed with mPCa, EBRT does not affect OS or CSS. In consequence, our findings question the added value of local EBRT in elderly newly diagnosed mPCa patients.

Keywords: EBRT; cancer-specific survival; elderly; local treatment; overall survival.

© 2021 The Authors. The Prostate published by Wiley Periodicals LLC.

References

REFERENCES

Mohler JL, Antonarakis ES, Armstrong AJ, et al. Prostate cancer, version 1.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2020.

Mottet N, van den Bergh R, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Eur Urol. 2020;79:243-262.

Parker CC, James ND, Brawley CD, et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet. 2018;392(10162):2353-2366.

Boevé LMS, Hulshof MCCM, Vis AN, et al. Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol. 2019;75(3):410-418.

Knipper S, Beyer B, Mandel P, et al. Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H. World J Urol. 2020;38(6):1459-1464.

Pompe RS, Tilki D, Preisser F, et al. Survival benefit of local versus no local treatment for metastatic prostate cancer-Impact of baseline PSA and metastatic substages. Prostate. 2018;78(10):753-757.

Stolzenbach LF, Deuker M, Collà-Ruvolo C, et al. External beam radiation therapy improves survival in low-volume metastatic prostate cancer patients: a North American population-based study. Prostate Cancer Prostatic Dis. 2020;24:253-260.

Rusthoven CG, Jones BL, Flaig TW, et al. Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer. J Clin Oncol. 2016;34(24):2835-2842.

Parikh RR, Byun J, Goyal S, Kim IY. Local therapy improves overall survival in patients with newly diagnosed metastatic prostate cancer. Prostate. 2017;77(6):559-572.

Leyh-Bannurah S-R, Gazdovich S, Budäus L, et al. Local therapy improves survival in metastatic prostate cancer. Eur Urol. 2017;72(1):118-124.

Wenzel M, Würnschimmel C, Nocera L, et al. Overall survival after systemic treatment in high-volume versus low-volume metastatic hormone-sensitive prostate cancer: systematic review and network meta-analysis. Eur Urol Focus. 2021;S2405-4569(21):00109-7. doi:10.1016/j.euf.2021.04.003

Brierley JD, Gospodarowicz MK, Wittekind C. The TNM Classification of Malignant Tumours. Wiley Blackwell; 2017.

Würnschimmel C, Wenzel M, Collà Ruvolo C, et al. Survival advantage of Asian metastatic prostate cancer patients treated with external beam radiotherapy over other races/ethnicities [published online ahead of print May 12, 2021]. World J Urol. doi:10.1007/s00345-021-03720-7

Würnschimmel C, Wenzel M, Collà Ruvolo C, et al. Life expectancy in metastatic prostate cancer patients according to racial/ethnic groups. Int J Urol. 2021;28(8):862-869. doi:10.1111/iju.14595

Dell'oglio P, Boehm K, Trudeau V, et al. Survival after conservative management versus external beam radiation therapy in elderly patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2016;96(5):1037-1045.

Abdollah F, Sun M, Thuret R, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988-2006. Eur Urol. 2011;59(1):88-95.

Knipper S, Dzyuba-Negrean C, Palumbo C, et al. External beam radiation therapy improves survival in high- and intermediate-risk non-metastatic octogenarian prostate cancer patients. Int Urol Nephrol. 2020;52(1):59-66.

Wilson JM, Dearnaley DP, Syndikus I, 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(5):1179-1189.

Löser A, Beyer B, Carl CO, et al. Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer. Strahlenther Onkol. 2019;195(5):374-382.

Wenzel M, Würnschimmel C, Chierigo F, et al. Non-cancer mortality in elderly prostate cancer patients treated with combination of radical prostatectomy and external beam radiation therapy. Prostate. 2021;81(11):728-735. doi:10.1002/pros.24169

Robinson TJ, Dinan MA, Li Y, Lee WR, Reed SD. Longitudinal trends in costs of palliative radiation for metastatic prostate cancer. J Palliat Med. 2015;18(11):933-939.

Dell'oglio P, Bandini M, Leyh-Bannurah S-R, et al. External beam radiotherapy with or without androgen deprivation therapy in elderly patients with high metastatic risk prostate cancer. Urol Oncol. 2018;36(5):239.e9-239.e15.

Tay KJ, Moul JW, Armstrong AJ. Management of prostate cancer in the elderly. Clin Geriatr Med. 2016;32(1):113-132.

16 Replies

Hello Patrick,

I'm now 80; diagnosed at 70. Conversation between my MO and me:

MO: "Nobody lives forever."

Me: "Records are made to be broken."

Attitude certainly helps.

Best, -Patrick

Hahaha, love it! Great mindset!

Best Regards

Definition of “elderly” is in the eyes (or opinion) of the observer. For me it is my age plus 10 years. Used to define middle aged in the same way. But that stopped working sometime after 50.I do sort of meet the ten miles before breakfast standard. I walk or hike 6 to 10 miles Nearly every day. And I don’t eat breakfast at all on my One-Meal-A-Day intermittent fasting. 😆

Perhaps another definition would be:Those men with metastatic PC who will not benefit with increased overall survival from aggressive therapies

There are different types of age such as Physical age, Mental age, biological age and emotional age...A75 years old man who walks/ runs 10 miles a day and does not have many serious medical conditions and is fit and trim....the biological age is 50 ..though physical age is 75.

Thanks for sharing this, though sadly disappointed with the study conclusion.

It will be interesting to see what specialist physicians say about this study.

LA hits some notes of resonance to identify with...

Physical, Mental, Emotional...

All can have "Age" standards associated with them. And for everyone, they can be and are different.

A lot of times, it's all within the control of the person themselves.

I know I have some family members that although in their 40's are still the mindset of 20 something! I have others who are very mature for their age! (I have a BIG family) lol...

Bottomed line is sometimes Soul Searching can help in providing an awakening, or the ability to see yourself without obstruction and have a real time assessment. Thought then is do you like what you see? Are you comfortable in your own skin? Do you own it and skip down the street not worrying about what others think? What most effects your thoughts here.

AGE for the most part, truly is a state of mind! And the MIND is a terrible thing to waste! Lol

The mind can power you through that workout you don't want to do. It can get you those 2 extra pushups. It can encourage you to see something through to it's conclusion, regardless of the results. It provides the mettle of which we are made of. I'm currently in the midst of all this and is why it is all fresh to mind and that I can maybe relate to it. Ultimately, it is different for everyone, but similar as well when we stumble across it.

Best Regards

One of my grandfathers when he developed dementia and or Alzheimer's my mom took him into her house and under her care. He was about 96 years old at that time (unfortunately not my biological grandfather lol).Every morning same thing " I know where I am but not how or why I am at your house".

She would re-explain every day.

He would ask sometimes how old am I. "How old do you think"?

Sometimes his reply was 50 other times 65.

His "old" memories were somewhat intact.

One day he saw a newspaper.

1998!!!!Jesus Christ!!!! He proclaimed in utter shock.

pjoshea13 profile image
pjoshea13 in reply to CAMPSOUPS

So, if I make it to 96 but my Alzheimer's gene has kicked in, I might still have some basic math skills? Good to know. LOL

I'm still 16 and act that way..............

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/13/2021 7:44 PM DST

SPEEDYX profile image
SPEEDYX in reply to j-o-h-n

In dog years!

j-o-h-n profile image
j-o-h-n in reply to SPEEDYX

Got me again LOL

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/13/2021 7:53 PM DST

SPEEDYX profile image
SPEEDYX in reply to j-o-h-n

Score is 25 to 5 your favor 😊

j-o-h-n profile image
j-o-h-n in reply to SPEEDYX

That's cause I cheat.............

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/13/2021 8:04 PM DST

** Click on watch on youtube **

youtube.com/watch?v=HCTunqv...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/13/2021 7:52 PM DST

You may also like...