Poor overall survival in septa- and octogenarian patients after radical prostatectomy and radiotherapy for prostate cancer: A population-based study of 6183 men

Objectives. The life expectancy of candidates for attempted curative therapy of prostate cancer should not be inferior to 10 yr. We examined the rate of 10-yr survival in septa- and octogenarians treated for prostate cancer with either attempted curative external beam radiotherapy (EBRT) or radical prostatectomy (RP). Methods: Within a population-based cohort of 17,570 EBRT or RP patients, 6183 men aged 70 yr or older were treated with either RP (n = 1591) or EBRT (n = 4592) and represented the focus of crude survival analyses. Age and Charlson Comorbidity index represented covariates. To control for prostate cancer-specific mortality, we repeated the analyses in a subset of 2704 men (RP, n = 881; EBRT,n = 1823) who had no clinical evidence of disease relapse of prostate cancer. Results: Overall actuarial 10-yr survival was 38.5% (RP 59.3% vs. EBRT 30.3%, p < 0.001) versus 36.5% in those without clinical evidence of disease relapse (RP 63.8% vs. EBRT 22.6%, p < 0.001). In multivariate Cox regression models, EBRT was associated with a 2.1-fold (p < 0.001) and 2.9-fold (p < 0.001) higher risk of mortality relative to RP in all men and in men without clinical evidence of disease relapse, respectively. Conclusions: Forty percent of septa- and octogenarian men who are selected for RP do not have adequate life expectancy to warrant attempted curative therapy. Even more strikingly, 70% of men who receive EBRT die before reaching the 10-yr mark. These findings may indicate the need for more stringent EBRT and RP selection criteria, if the goal is to minimise overtreatment. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.