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World J Urol. 2015 Dec;33(12):1985-91. doi: 10.1007/s00345-015-1553-0. Epub 2015 Apr 9.

Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians.

Author information

1
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
2
Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
3
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. boehm@martini-klinik.de.
4
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. boehm@martini-klinik.de.
5
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
6
INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique, Laval, QC, Canada.
7
University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
8
Department of Radiation Oncology, University of Montreal Health Center, Montreal, QC, Canada.
9
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

BACKGROUND:

Brachytherapy (BT) is a widely used treatment modality for elderly patients with localized prostate cancer (PCa).

OBJECTIVE:

To describe the patterns of BT use in octo- and nonagenarians treated for localized PCa in the USA. We hypothesized that most individuals treated with BT should remain alive for at least 10 years. We also postulated that BT should ideally be administered as monotherapy.

PATIENTS AND METHODS:

Using the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, 2701 octo- and nonagenarians treated with BT between 1992 and 2009 were identified. Cumulative incidence rates and smoothed cumulative incidence plots were used.

RESULTS:

In patients with low-risk characteristics, 40 % received BT alone; 27 % received BT combined with ADT; 19 % received BT and EBRT; and 14 % received BT combined with both ADT and EBRT. Of intermediate-to-high-risk patients, 19 % received BT alone; 16 % received BT combined with ADT; 19 % received BT combined with EBRT; and 45 % received BT together with ADT and EBRT. Overall survival rate was 79 and 47 % at 5 and 10 years.

CONCLUSIONS:

Less than half of elderly treated with BT remain alive at 10 years of follow-up. Moreover, the vast majority of those individuals not only receives BT, but is also exposed to two or even three combined therapy modalities. These findings are worrisome.

KEYWORDS:

Brachytherapy; Elderly patients; Localized prostate cancer; Octo- and nonagenarians; Prostate cancer; Survival

PMID:
25854524
DOI:
10.1007/s00345-015-1553-0
[Indexed for MEDLINE]

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