Outcomes of dose-escalated IMRT and ADT in Octogenarians with prostate cancer.

Abstract

We evaluated long-term outcomes for octogenarians with localised prostate cancer treated using dose-escalated image-guided intensity-modulated radiation therapy (IMRT) at our institution. The charts of octogenarians treated for localised prostate cancer were retrospectively reviewed. Overall survival (OS), prostate cancer-specific survival (PCaSS), toxicity rates and changes from baseline were collected. The median follow-up was 97 months. Of 107 eligible patients, 27.1% had intermediate-risk and 72.9% had high-risk localised prostate cancer. Median dose was 78Gy, and 97.2% received ADT. OS was 91.4% and 67.2% at 5 and 10 years. PCaSS was 98.0% and 88.7% at 5 and 10 years. In all, 39 (36.4%) of patients died, with the cause of death known in 30: in 26.7% of these patients, prostate cancer was the cause of death. Grade ≥ 2 late GI and GU toxicity was 0.9% and 24.3% respectively. In all, 11.2% and 22.4% of patients reported worsening of GI or GU function from baseline, and 13.1% and 21.5% reported improvement in GI and GU function compared to baseline. Selected octogenarian patients with localised prostate cancer appear to benefit from radiation therapy and ADT. Despite excellent long-term PCaSS, 26.7% of patients died of prostate cancer. Rates of GI and GU toxicity were acceptable, and deterioration of urinary and bowel function compared to baseline was just as common as improvement in function from baseline.