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Among older men with high-risk prostate cancer, receiving androgen-deprivation therapy in combination with radiotherapy reduced cause-specific and all-cause mortality by as much as 50% when compared with those who received androgen-deprivation therapy alone, results from a large-scale data review showed.
In fact, men over the age of 65 with locally advanced prostate cancer risk significantly higher mortality rates if they are treated with androgen-deprivation therapy (ADT) without accompanying radiotherapy (RT), according to the authors of a study published online Jan. 5 in the Journal of Clinical Oncology.
“Our findings raise a provocative hypothesis that in the United States, men age 75 years (or older) with locally advanced prostate cancer or men age 65 years (or older) with high-risk screen-detected prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival,” wrote Dr. Justin E. Bekelman and his associates (J. Clin. Oncol. 2015 Jan. 5 [doi:10.1200/JCO.2014.57.2743]).
The large-scale data review, led by Dr. Bekelman of the University of Pennsylvania, Philadelphia, examined 31,451 men who developed prostate cancer between the ages of 65 and 85 whose medical records were included in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men were diagnosed between 1995 and 2007 and observed through 2009.
The patients examined in the study were divided into three cohorts, including a primary cohort (which included men aged 65 to 75 years and was consistent with participants in randomized, controlled trials); an elderly cohort (which included men from 75 to 85 years old with locally advanced prostate cancer); and a screen-detected cohort (which included men over 65 years old with screen-detected high-risk prostate cancer).
Among men aged 76-85, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 5.0% of patients, compared with ADT alone at 7 years follow-up. Among men aged 65-75, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% compared with ADT alone at 7 years follow-up.
Though a number of studies have examined the effects of combination therapy for prostate cancer, the authors noted that geriatric patients are underrepresented in efficacy trials for prostate cancer therapy. In addition, androgen-deprivation therapy by itself is particularly common among patients older than 75, with 40% of patients in that age group receiving ADT without accompanying RT.
“The lack of evidence to guide prostate cancer treatment decisions among older men and those with screen-detected high-risk tumors stands as a special priority among the many evidence gaps in the treatment of prostate cancer,” the authors wrote.
In addition to confirming findings from the randomized, controlled trials, the study by Bekelman et al. has important implications, given that it highlights the prevalent age bias against the use of radiotherapy in elderly men with high-risk prostate cancer. Much of the public discourse relating to prostate cancer emphasizes the overtreatment of low-risk prostate cancer in men who are least likely to die as a result of prostate cancer. Nevertheless, given the weight of evidence favoring the addition of RT to androgen-deprivation therapy for high-risk disease, one must question why, in the population analyzed by Dr. Bekelman and his associates, 49% of men older than age 65 years with locally advanced or high-risk prostate cancer were treated with ADT monotherapy, a rate that increased to 61% in those aged 75 years or older.
In elderly men who are sufficiently healthy to tolerate ADT, careful consideration should be given to also treating with RT, which is associated with substantial improvements in disease-specific and overall survival and can be delivered with minimal morbidity using modern treatment techniques.
Dr. Dean A. Shumway and Dr. Daniel A. Hamstra are radiologists with the University of Michigan, Ann Arbor. These remarks were part of an editorial accompanying the report (J. Clin. Onc. 2015 Jan 5. [doi:10.1200/JCO.2014.59.4093]). Dr. Shumway had no disclosures to report. Dr. Hamstra received research funding from Novartis and has advisory roles with Myriad Genetics and Teva.
In addition to confirming findings from the randomized, controlled trials, the study by Bekelman et al. has important implications, given that it highlights the prevalent age bias against the use of radiotherapy in elderly men with high-risk prostate cancer. Much of the public discourse relating to prostate cancer emphasizes the overtreatment of low-risk prostate cancer in men who are least likely to die as a result of prostate cancer. Nevertheless, given the weight of evidence favoring the addition of RT to androgen-deprivation therapy for high-risk disease, one must question why, in the population analyzed by Dr. Bekelman and his associates, 49% of men older than age 65 years with locally advanced or high-risk prostate cancer were treated with ADT monotherapy, a rate that increased to 61% in those aged 75 years or older.
In elderly men who are sufficiently healthy to tolerate ADT, careful consideration should be given to also treating with RT, which is associated with substantial improvements in disease-specific and overall survival and can be delivered with minimal morbidity using modern treatment techniques.
Dr. Dean A. Shumway and Dr. Daniel A. Hamstra are radiologists with the University of Michigan, Ann Arbor. These remarks were part of an editorial accompanying the report (J. Clin. Onc. 2015 Jan 5. [doi:10.1200/JCO.2014.59.4093]). Dr. Shumway had no disclosures to report. Dr. Hamstra received research funding from Novartis and has advisory roles with Myriad Genetics and Teva.
In addition to confirming findings from the randomized, controlled trials, the study by Bekelman et al. has important implications, given that it highlights the prevalent age bias against the use of radiotherapy in elderly men with high-risk prostate cancer. Much of the public discourse relating to prostate cancer emphasizes the overtreatment of low-risk prostate cancer in men who are least likely to die as a result of prostate cancer. Nevertheless, given the weight of evidence favoring the addition of RT to androgen-deprivation therapy for high-risk disease, one must question why, in the population analyzed by Dr. Bekelman and his associates, 49% of men older than age 65 years with locally advanced or high-risk prostate cancer were treated with ADT monotherapy, a rate that increased to 61% in those aged 75 years or older.
In elderly men who are sufficiently healthy to tolerate ADT, careful consideration should be given to also treating with RT, which is associated with substantial improvements in disease-specific and overall survival and can be delivered with minimal morbidity using modern treatment techniques.
Dr. Dean A. Shumway and Dr. Daniel A. Hamstra are radiologists with the University of Michigan, Ann Arbor. These remarks were part of an editorial accompanying the report (J. Clin. Onc. 2015 Jan 5. [doi:10.1200/JCO.2014.59.4093]). Dr. Shumway had no disclosures to report. Dr. Hamstra received research funding from Novartis and has advisory roles with Myriad Genetics and Teva.
Among older men with high-risk prostate cancer, receiving androgen-deprivation therapy in combination with radiotherapy reduced cause-specific and all-cause mortality by as much as 50% when compared with those who received androgen-deprivation therapy alone, results from a large-scale data review showed.
In fact, men over the age of 65 with locally advanced prostate cancer risk significantly higher mortality rates if they are treated with androgen-deprivation therapy (ADT) without accompanying radiotherapy (RT), according to the authors of a study published online Jan. 5 in the Journal of Clinical Oncology.
“Our findings raise a provocative hypothesis that in the United States, men age 75 years (or older) with locally advanced prostate cancer or men age 65 years (or older) with high-risk screen-detected prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival,” wrote Dr. Justin E. Bekelman and his associates (J. Clin. Oncol. 2015 Jan. 5 [doi:10.1200/JCO.2014.57.2743]).
The large-scale data review, led by Dr. Bekelman of the University of Pennsylvania, Philadelphia, examined 31,451 men who developed prostate cancer between the ages of 65 and 85 whose medical records were included in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men were diagnosed between 1995 and 2007 and observed through 2009.
The patients examined in the study were divided into three cohorts, including a primary cohort (which included men aged 65 to 75 years and was consistent with participants in randomized, controlled trials); an elderly cohort (which included men from 75 to 85 years old with locally advanced prostate cancer); and a screen-detected cohort (which included men over 65 years old with screen-detected high-risk prostate cancer).
Among men aged 76-85, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 5.0% of patients, compared with ADT alone at 7 years follow-up. Among men aged 65-75, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% compared with ADT alone at 7 years follow-up.
Though a number of studies have examined the effects of combination therapy for prostate cancer, the authors noted that geriatric patients are underrepresented in efficacy trials for prostate cancer therapy. In addition, androgen-deprivation therapy by itself is particularly common among patients older than 75, with 40% of patients in that age group receiving ADT without accompanying RT.
“The lack of evidence to guide prostate cancer treatment decisions among older men and those with screen-detected high-risk tumors stands as a special priority among the many evidence gaps in the treatment of prostate cancer,” the authors wrote.
Among older men with high-risk prostate cancer, receiving androgen-deprivation therapy in combination with radiotherapy reduced cause-specific and all-cause mortality by as much as 50% when compared with those who received androgen-deprivation therapy alone, results from a large-scale data review showed.
In fact, men over the age of 65 with locally advanced prostate cancer risk significantly higher mortality rates if they are treated with androgen-deprivation therapy (ADT) without accompanying radiotherapy (RT), according to the authors of a study published online Jan. 5 in the Journal of Clinical Oncology.
“Our findings raise a provocative hypothesis that in the United States, men age 75 years (or older) with locally advanced prostate cancer or men age 65 years (or older) with high-risk screen-detected prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival,” wrote Dr. Justin E. Bekelman and his associates (J. Clin. Oncol. 2015 Jan. 5 [doi:10.1200/JCO.2014.57.2743]).
The large-scale data review, led by Dr. Bekelman of the University of Pennsylvania, Philadelphia, examined 31,451 men who developed prostate cancer between the ages of 65 and 85 whose medical records were included in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men were diagnosed between 1995 and 2007 and observed through 2009.
The patients examined in the study were divided into three cohorts, including a primary cohort (which included men aged 65 to 75 years and was consistent with participants in randomized, controlled trials); an elderly cohort (which included men from 75 to 85 years old with locally advanced prostate cancer); and a screen-detected cohort (which included men over 65 years old with screen-detected high-risk prostate cancer).
Among men aged 76-85, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 5.0% of patients, compared with ADT alone at 7 years follow-up. Among men aged 65-75, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% compared with ADT alone at 7 years follow-up.
Though a number of studies have examined the effects of combination therapy for prostate cancer, the authors noted that geriatric patients are underrepresented in efficacy trials for prostate cancer therapy. In addition, androgen-deprivation therapy by itself is particularly common among patients older than 75, with 40% of patients in that age group receiving ADT without accompanying RT.
“The lack of evidence to guide prostate cancer treatment decisions among older men and those with screen-detected high-risk tumors stands as a special priority among the many evidence gaps in the treatment of prostate cancer,” the authors wrote.
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Androgen-deprivation therapy in combination with radiotherapy is superior to androgen-deprivation therapy alone in geriatric cancer patients.
Major finding: ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% among men aged 65-75, compared with ADT alone at 7 years follow-up.
Data source: A large-scale data review of 31, 541 prostate cancer patients ranging in age from 65 years to 85 years using the SEER Medicare database.
Disclosures: Dr. Bekelman had no disclosures to report.
