Survival Following Radiation and Androgen Suppression Therapy for Prostate Cancer in Healthy Older Men: Implications for Screening Recommendations
Received 16 December 2008; received in revised form 29 January 2009; accepted 29 January 2009. published online 22 April 2009.
Purpose
The U.S. Preventive Services Task Force has recommended against screening men over 75 for prostate cancer. We examined whether older healthy men could benefit from aggressive prostate cancer treatment.
Methods and Materials
206 men with intermediate to high risk localized prostate cancer randomized to 70 Gy of radiation (RT) or RT plus 6 months of androgen suppression therapy (RT+AST) constituted the study cohort. Within subgroups stratified by Adult Comorbidity Evaluation-27 comorbidity score and age, Cox multivariable analysis was used to determine whether treatment with RT+AST as compared with RT was associated with a decreased risk of death.
Results
Among healthy men (i.e., with mild or no comorbidity), 78 were older than the median age of 72.4 years, and in this subgroup, RT+AST was associated with a significantly lower risk of death on multivariable analysis (adjusted hazard ratio = 0.36 (95% CI=0.13-0.98), p = 0.046, with significantly lower 8-year mortality estimates of 16.5% vs. 41.4% (p = 0.011). Conversely, among men with moderate or severe comorbidity, 24 were older than the median age of 73, and in this subgroup, treatment with RT+AST was associated with a higher risk of death (adjusted hazard ratio = 5.2 (1.3-20.2), p = 0.018).
Conclusion
In older men with mild or no comorbidity, treatment with RT+AST was associated with improved survival compared with treatment with RT alone, suggesting that healthy older men may derive the same benefits from prostate cancer treatment as younger men. We therefore suggest that prostate cancer screening recommendations should not be based on strict age cutoffs alone but should also take into account comorbidity.
†Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
¶Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
‡Department of Statistics, University of Connecticut, Storrs, CT
§Department of Pathology, Baptist Hospital of Miami, Miami, FL
Reprint requests to: Paul L. Nguyen, MD, Harvard Radiation Oncology Program, Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Tel: (616) 732-6310; Fax: (617) 732-7347
ABSTRACT