SAN FRANCISCO—Elderly men who receive definitive local treatment for prostate cancer (PCa) are much more likely to die from causes other than their cancer, a finding that could inform doctor-patient discussions about treatment for localized PCa, investigators reported here at the annual Genitourinary Cancers Symposium.
Researchers who studied 4,237 men aged 65 years or older who were treated with radical prostatectomy (1,634 men), external-beam radiotherapy (1,570 men), or brachytherapy (1033 men) found that the risk of PCa-specific mortality (PCSM) compared with competing causes of mortality (CCM) is low, especially for patients with moderate-to-severe comorbidity.
“Even if you had high-risk prostate cancer and no comorbidities, you were still much more likely to die of other causes than you were from prostate cancer,” observed investigator Joseph C. Klink, MD, of the Cleveland Clinic, who presented study findings.
Over a median follow-up of 72 months, investigators observed 88 and 748 PCSM and CCM events, respectively. Among healthy men with low-risk PCa, 10-year PCSM was 2% and CCM was 19%. Among healthy men with high-risk PCa, PCSM was 11% and CCM was 27%.
In a group of patients with moderate-to-severe comorbidities, PCSM was 1%, 3%, and 21% for men with low-, intermediate-, and high-risk PCa, respectively, whereas CCM was 49%, 59%, and 58%, respectively.
The investigators noted that current evidence suggests that local treatment for PCa is associated with a 25% reduction in PCSM at best. Therefore, they observed, with active surveillance, it is unlikely that PCSM would exceed 5%-7% in patients with low- and intermediate-risk PCa.
The symposium is cosponsored by the American Society of Clinical Oncology, the American Society of Radiation Oncology, and the Society of Urologic Oncology.