Abstract
Background:The survival benefit of active treatment for high-risk prostate cancer patients aged≥ 75 years remains controversial. We further evaluated the effect of definitive treatment(DT) for those patients in a population-based cohort.Methods:Retrospective analysis of 17848 elderly (≥75 years) men in the Surveillance, Epidemiology, and End Results(SEER) database(2004-2016) who diagnosed non-metastatic high-risk prostate cancer. Kaplan-Meiersurvival curves were used to compare cancer-specific survival (CSS) and overall survival (OS). Propensity-adjusted multivariate Cox regression analysis fitted to identify independent prognostic factors. Logistic regression models were used as a predictor for DT.Results:A total of 17848 patients were identified, 10365 patients receiving DT (including 4284 receiving surgery, 5683 receiving EBRT, 367 receiving BT, 569 receiving EBRT+BT, 92receiving Chemotherapy) and 7473 receiving non-DT. PSM methods wereperformedand compared all baseline factors, including insurance/marital status, age, race,T /N stage, grade, Gleason score(GS),PSA. After PSM, these two groups achieved a median survival time (MST) of 99, 67months for OS, respectively(P<0.01).And older age (age ≥ 80 years) status showed a worse survival benefit (P<0.01). The subgroup analysis illustrated that surgery(MST=122) vsEBRT(MST=111) vs BT(MST=116) vs EBRT+BT(MST=121) subgroups achieved better OS than Chemotherapy group(MST=66)(P<0.01). However, EBRT+BT subgroup had better 3- and 5-year OS (93% and 82.2%). Multivariate Cox proportional hazards model showed unmarried status, older age (age ≥ 80 years), T4 stage, high tumor grade, PSA ≥10 ng/mL were significantly associated with a worse OS, whereas DT (HR, 0.65; p < 0.001) and other race(HR, 0.773; p < 0.001) were associated with a better OS. And logistic regression illustrated that poor differentiated grade was independently predictor (OR=1.427;p=0.022)Conclusions: This study indicated that insurance status, marital status, age, race, T /N stage, grade, GS, PSA and treatment modalities affected OS and CSS in elderly men with non-metastatic high-risk prostate cancer. DT, especially surgery and radiotherapy, might provide favorable OS not CSS compared with NDT for older patients (≥75 years), whereas chemotherapy was not recommended.
Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study
