Abstract
BackgroundFor localized prostate cancer (PCa), radical prostatectomy (RP) and radiotherapy (RT) are two standard interventions to decrease PCa mortality. Contemporary studies contained the elderly people; analyses focusing on patients over 75 years of age were still lacking.MethodIn the Surveillance Epidemiology and End Results (SEER) database (2004‐2015), people over 75 years of age with cT2 stage were selected in our research. Multivariable Cox proportional hazard models were used to analyze cancer‐specific mortality (CSM) and overall mortality (OM) after adjustment. The propensity score matching was performed to assume the randomization. An instrument variate (IVA) was used to calculate the unmeasured confounders.ResultsRadical prostatectomy is superior to RT in OM and CSM after adjustment for covariates (HR = 0.54, 95% CI = 0.47‐0.62, P < 0.001 and HR = 0.30, 95% CI = 0.20‐0.45, P < 0.001, respectively). The cox model after matching indicated similar consequence (OM: HR = 0.53, 95% CI = 0.46‐0.62, P < 0.001; CSM: HR = 0.27, 95% CI = 0.17‐0.43, P < 0.001). In the IVA‐adjusted model, the effect of treatment changed slightly (OM: HR = 0.65, 95% CI = 0.54‐0.78, P < 0.001; CSM: HR = 0.21, 95% CI = 0.12‐0.37, P < 0.001). Subgroup analyses showed that for patients with GS = 7, those received RP obtained the highest risk decline for overall death (HR = 0.41, 95% CI = 0.32‐0.52); and for patients with younger age, those received RP obtained the highest risk decline for CSM (HR = 0.11, 95% CI = 0.01‐0.52).ConclusionPatients over 75 years of age with cT2 stage will obtain more benefit from RP compared with RT, especially for patients with GS = 7 and younger age.
Highlights
Prostate cancer (PCa) is the second most common cancer in males, with an estimated 1.1 million confirmed cases worldwide in 2012, making up 15% deaths of all cancers diagnosed.[1]
PaƟents diagnosed with prostate cancer between 2004-2015 from Surveillance Epidemiology and End Results (SEER) database (n = 665 054)
Results of the multivariate Cox proportional hazard regression showed that radical prostatectomy (RP) could reduce more risks of overall mortality (OM) and cancer‐specific mortality (CSM) after adjusted for race, age, marital status, Gleason Score (GS) and prostate specific antigen (PSA)
Summary
Prostate cancer (PCa) is the second most common cancer in males, with an estimated 1.1 million confirmed cases worldwide in 2012, making up 15% deaths of all cancers diagnosed.[1] This disease primarily encroaches on the elderly with age‐related increasing incidence rates.[2]. Autopsy studies suggest that high‐grade intraepithelial neoplasia, the precursor of incidental PCa, are detected more among the old Another European research showed that for men between 30 and years of age, the prevalence of incidental PCa was 30% and sharply increased to 75% for those over years of age.[3]. Three retrospective studies indicated that people received RP was superior to RT in terms of biochemical recurrence, metastasis‐free survival, and CSS.[7-9]. These studies contained patients of all T stages and none of these focused on the elderly.
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