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Abstract
Curative radiotherapy for prostate cancer is common in the elderly. However, concerns about potential toxicity have inhibited access to radiotherapy for this population, for whom preserving quality of life (QoL) is crucial. The primary endpoint was to identify predictors of impaired QoL in men aged 75 years or older treated with curative intent radiotherapy with or without androgen deprivation therapy (ADT) for localized prostate cancer. We prospectively performed comprehensive geriatric assessment (CGA) and administered QoL questionnaires to 208 elderly (>75 years) patients prior to, plus two and six months after, radiotherapy (NCT 02876237). The median age of the patients was 77 years (range 75–89). At the start of the study, comorbidities were highlighted in 65% of patients: 23% were depressed, 23% had cognitive impairment, and 16% had reduced independence. At six months, 9% of patients had a consistently decreased QoL (>20 points), and a further 16% had a more moderate reduction (10 to 20 points) in QoL. None of the parameters studied (tumor characteristic, treatment, or oncogeriatric parameters) were predictive of a reduced QoL following radiotherapy. Though co-existing geriatric impairment was common, QoL was maintained for 75% of patients six months after radiotherapy. CGA was poorly predictive of tolerance of prostatic radiotherapy. Geriatric assessments dedicated to quality of life following radiotherapy need to be developed.
Highlights
Incidence of prostate cancer is on the increase in Western countries, especially in the elderly, and determining the best treatment to offer this heterogeneous population is a challenging issue
The aim of our study was to use initial clinical or geriatric settings to identify the patients at risk of quality of life (QoL) impairment after prostate cancer radiotherapy
As our study population seemed representative of the routine clinical elderly prostate cancer population, we suggest that earlier fears of radiotherapy toxicity in this group may have been overemphasized
Summary
Incidence of prostate cancer is on the increase in Western countries, especially in the elderly, and determining the best treatment to offer this heterogeneous population is a challenging issue. Palliative treatment (androgen deprivation therapy (ADT) or no therapy at all) is offered to most patients over the age of 75 years with localized high-risk prostate cancer [1], despite the proven improvement in survival induced by radiotherapy [2]. We chose to evaluate early quality of life after radiotherapy because we have previously shown, in a younger population, that there is a temporary decrease in QoL after intensity-modulated radiation therapy (IMRT) for prostate cancer [3], but that most symptoms resolve within 6 months and long-term quality of life is usually similar to baseline [4]. Good tolerance of prostate cancer radiotherapy in the elderly has been reported in retrospective studies [5], but there is a lack of prospective data
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