Survival outcomes in octogenarian and nonagenarian patients treated with first-line androgen deprivation therapy for organ-confined prostate cancer

Abstract

Background: The use of primary androgen deprivation therapy (PADT) is common in elderly men with early-stage prostate cancer (PCa), despite the absence of guideline recommendations.Objective: To examine survival patterns of octo- and nonagenarian men with organ-confined PCa exposed Lo PADT, to assess whether their life expectancy warrants androgen deprivation therapy use.Design, setting, and participants: In the Surveillance, Epidemiology, and End Results-Medicare-linked database, we identified 14785 octo- and nonagenarian organ-confined PCa patients treated with PADT between 1991 and 2009.Outcome measurements and statistical analysis: The smoothed cumulative incidence method was used to examine 10-yr overall mortality, cancer-specific mortality (CSM), and other-cause mortality (OCM) rates. Multivariable Cox regression analyses focused on the combined effect of age and Charlson comorbidity index (CCI) after adjusting for different confounders.Results and limitations: Of all the deaths observed during the study period, 80% were due to noncancer causes and 20% were due to PCa. The 10-yr overall survival (OS) rate in the overall population was 15.4%. The 10-yr OS rates ranged from 19.9% in patients aged 80-84 yr to 3.1% in those aged >= 90 yr. Similarly, the 10-yr OS rates ranged from 18.7% in patients with CCI = 0 to 11.5% in those with CCI >= 2. The 10-yr OCM rate in the overall population was 68.2%. The 10-yr OCM rates ranged from 64.6% in patients aged 80-84 yr to 77.2% in patients aged >= 90 yr. Similarly, the 10-yr OCM rates ranged from 62.1% in patients with CCI = 0 to 75.2% in those with CCI >= 2. The 10-yr CSM rate in the overall population was 16.4%. The 10-yr CSM rates ranged from 15.5% in patients aged 80-84 yr to 19.7% in those aged >= 90 yr, and from 19.2% in patients with CCI = 0 to 13.3% in those with CCI >= 2.Conclusions: Of the elderly patients with organ-confined PCa exposed to PADT, only 15% survive at 10-yr follow-up. Mortality related to non-cancer causes is the leading cause of death in the same follow-up period. These figures question the rationale for PADT in elderly men with organ-confined PCa.Patient summary: In this study, we looked at the survival patterns of octo- and nonagenarians treated with primary androgen deprivation therapy for organ-confined prostate cancer. We found that a small proportion of patients who received primary androgen deprivation therapy remain alive at 10-yr follow-up, and the leading cause of death was not attributable to prostate cancer. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.