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Shahait M, Dobbs RW, Kim JL, Eldred N, Liang K, Huynh LM, Ahlering TE, Patel V, Lee DI. Perioperative and Functional Outcomes of Robot-Assisted Radical Prostatectomy in Octogenarian Men. J Endourol 2021; 35:1025-1029. [PMID: 33267679 DOI: 10.1089/end.2020.0859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The functional and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in octogenarians are not well studied. We sought to study the perioperative, functional, and oncologic outcomes of RARP in octogenarian men. Methods: Between January 2009 and 2019, 46 patients ≥80 years with localized prostate cancer (PCa) underwent RARP in three high-volume robotic urologic practices in the United States. Clinical and pathologic features, and perioperative and postoperative complications were retrospectively evaluated. Functional outcomes for urinary and sexual function were collected via patient-reported questionnaires. Continence was defined as the use of zero or one safety pad per day. Results: The median (interquartile range) age was 81 (80-82), the mean (standard deviation [SD]) operative time was 116.5 (36.4) minutes, and the mean (SD) blood loss was 132 (35.6) mL. All cases were completed robotically, no intraoperative complications were encountered, and the mean length of stay was 1.21 (0.78) days. Regarding 30- and 90-day complication, nine patients had postoperative complications; seven were Clavien-Dindo grade I-II, and two were Clavien-Dindo grade ≥III. Post-RARP continence rates at 3 and 12 months were 68.4% and 84.8%, respectively. Conclusions: RARP represents a feasible option to treat PCa in well-selected octogenarian men. Careful patient selection and counseling are critical before offering surgical treatment for these men.
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Affiliation(s)
- Mohammed Shahait
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,King Hussein Cancer Center, Amman, Jordan
| | - Ryan W Dobbs
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica L Kim
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy Eldred
- Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Karren Liang
- Department Urology, University of California Irvine, Orange, California, USA
| | - Linda M Huynh
- Department Urology, University of California Irvine, Orange, California, USA
| | - Thomas E Ahlering
- Department Urology, University of California Irvine, Orange, California, USA
| | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - David I Lee
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zhao F, Shen J, Yuan Z, Yu X, Jiang P, Zhong B, Xiang J, Ren G, Xie L, Yan S. Trends in Treatment for Prostate Cancer in China: Preliminary Patterns of Care Study in a Single Institution. J Cancer 2018; 9:1797-1803. [PMID: 29805706 PMCID: PMC5968768 DOI: 10.7150/jca.25113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/13/2018] [Indexed: 11/05/2022] Open
Abstract
Objectives: A Patterns of Care Study (PCS) was performed in the largest regional medical center in Zhejiang Province, China. The hospital information system (HIS) was used to evaluate patient characteristics and changes in initial treatment patterns for prostate cancer and to determine recent predominant trends in treatment plans for prostate cancer (PCa) in China. Methods: Men who were newly diagnosed with localized or locally advanced PCa for 2010-2011 and 2016-2017 were identified in the HIS database. Patient characteristics and temporal trends in initial management were assessed, and differences between groups were evaluated for significance using Chi-square and Mann-Whitney U tests. Results: In total, 1792 patients met the study criteria, including 505 and 1287 patients in the 2010-2011 and 2016-2017 samples, respectively. The average age of patients diagnosed in the 2010-2011 PCS survey was 70 years, decreasing to 68 years when the 2016-2017 patients were included (P<0.001). In the 2010-2011 sample, 50.69% of the patients had an initial prostate-specific antigen (PSA) level ≥20 ng/ml. In contrast, the initial PSA level was 4-19.99 ng/ml for 66.67% of the patients in the 2016-2017 sample (P<0.001). Based on National Comprehensive Cancer Network (NCCN) criteria, the percentages of patients in low- and intermediate-risk groups increased from 33.06% to 54.78%; conversely, the percentages in high-risk, very high-risk, and regional (N1) groups decreased to a certain extent (P<0.001). According to European Association of Urology (EAU) criteria, the percentages of patients in low- and intermediate-risk groups increased from 32.07% to 53.69%, yet the percentage in the high-risk group decreased (P<0.001). The use of radical prostatectomy (RP) and radiation therapy (RT) increased from 48.32% to 76.46% and 5.35% to 16.94%, particularly in high-risk and low-risk groups, respectively, whereas the rates of hormone therapy (HT) and active surveillance and observation (AS&O) decreased from 32.28% to 4.27% and from 16.04% to 2.33%, respectively (P<0.001). A similar pattern was observed when patients were stratified by EAU risk group. Conclusions: The results of this real-world study in the largest regional medical center in Zhejiang Province, China, indicate that the predominant characteristics of PCa patients and trends in initial management are changing rapidly. We found the following: (a) a trend toward a decreased age among newly diagnosed patients; (b) a trend toward lower initial PSA levels; (c) a downward trend in risk group classification; (d) a significant increase in the likelihood of receiving RP, particularly in the high-risk group; (e) an increase in the rate of RP, mostly due to use of the Da Vinci robotic system; (f) a significant increase in the likelihood of receiving RT, especially in the low-risk group; and (g) a decrease in HT and AS&O.
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Affiliation(s)
- Feng Zhao
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jiayan Shen
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zuguo Yuan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Xiaokai Yu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Peng Jiang
- Department of Urology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Baishu Zhong
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jianjian Xiang
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Guoping Ren
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Liping Xie
- Department of Urology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Senxiang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Ryu JH, Kim SJ, Kim YB, Jung TY, Ko WJ, Kim SI, Kim DY, Oh TH, Moon KT, Cho HJ, Cho JM, Yoo TK. Radical prostatectomy for clinically localized prostate cancer in patients aged 75 years or older: comparison with primary androgen deprivation therapy. Aging Male 2018; 21:17-23. [PMID: 28828908 DOI: 10.1080/13685538.2017.1365122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine whether radical prostatetomy (RP) is suitable for prostate cancer patients with age ≥75 years in comparison to primary androgen deprivation therapy (PADT). PATIENTS AND METHODS A cohort study was conducted in clinically localized prostate cancer patients with ≥75 years of age who underwent RP or PADT at six institutions from 2005 to 2013. Patients who had less than 12 months of follow-up, or received neoadjuvant or adjuvant therapy were excluded. We compared clinical characteristics, cancer-specific and overall survivals, and post-treatment complication rates between two groups. RESULTS We included 92 and 99 patients in the RP and PADT groups, respectively. In survival analyses, there were no significant differences in cancer-specific and overall survivals (p = .302 and .995, respectively). The incidence of serious adverse events (cardio- or cerebrovascular event, or bone fracture) was higher in the PADT group (p = .001). Multivariable analysis showed that PADT had a worse effect on the serious adverse events (OR 10.12, p = .038). CONCLUSIONS In selected elderly patients, RP was safe and effective for treatment of localized prostate cancer, as compared to PADT. Surgical treatment options should be considered in elderly patients with respect to life expectancy, rather than chronological age.
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Affiliation(s)
- Jae Hyun Ryu
- a Department of Urology , Veterans Health Service Medical Center , Seoul , Republic of Korea
| | - Sang Jin Kim
- a Department of Urology , Veterans Health Service Medical Center , Seoul , Republic of Korea
| | - Yun Beom Kim
- a Department of Urology , Veterans Health Service Medical Center , Seoul , Republic of Korea
| | - Tae Young Jung
- a Department of Urology , Veterans Health Service Medical Center , Seoul , Republic of Korea
| | - Woo Jin Ko
- b Department of Urology, National Health Insurance Corporation Ilsan Hospital , Goyang , Republic of Korea
| | - Sun Il Kim
- c Department of Urology, Ajou University School of Medicine , Suwon , Republic of Korea
| | - Duk Yoon Kim
- d Department of Urology, Catholic University of Daegu School of Medicine , Daegu , Republic of Korea
| | - Tae Hee Oh
- e Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Republic of Korea
| | - Kyong Tae Moon
- f Department of Urology, Eulji General Hospital, Eulji University School of Medicine , Seoul , Republic of Korea
| | - Hee Ju Cho
- f Department of Urology, Eulji General Hospital, Eulji University School of Medicine , Seoul , Republic of Korea
| | - Jeong Man Cho
- f Department of Urology, Eulji General Hospital, Eulji University School of Medicine , Seoul , Republic of Korea
| | - Tag Keun Yoo
- f Department of Urology, Eulji General Hospital, Eulji University School of Medicine , Seoul , Republic of Korea
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Abstract
INTRODUCTION We set out to evaluate outcomes in patients over 74 after robotic radical prostatectomy. MATERIALS AND METHODS Six hundred forty-seven patients over 74 (≥75) were analyzed for preoperative factors (body mass index [BMI], American Society of Anestesiologists classification [ASA], prostate-specific antigen [PSA], International prostate symptome score [IPSS], International index of erectile function [IIEF]), operative and perioperative characteristics (technique, erythrocyte conc., complications), and histopathological results. After 12 months, following items were assessed: PSA, frequency of urine loss, number of pads used (including safety), incontinence at night, and potency as quantified by IIEF-5. RESULTS Mean age in the group <75 was 64.8 years (range 46-74 years) and in the group ≥75 76.9 years (75-88). No statistically significant differences could be detected in terms of BMI, ASA score, or preoperative PSA, respectively. IPSS and IIEF were significantly worse in the group ≥75. Major complications (>Clavien-Dindo III) were found in 1.6% vs. 1.3% (≥75) of cases. Minor complications were encountered in 22.8% vs. 26.3% (≥75). There was a remarkably high percentage of locally advanced disease (73.3% vs. 71.0%) in both groups. Patients ≥75 showed a tendency toward more aggressive cancer and more frequent nodal involvement; we found a higher percentage of R1-resections (19.5% vs. 30.4%, p < 0.05) and PSA relapse after 1 year (12.3% vs. 22.8%, p < 0.05). Twelve months pad-free continence rate (69.9% vs. 63.2%) showed no statistically significant difference between both groups as did the preservation rate of erectile function. CONCLUSION We could show that robotic prostatectomy can be carried out safely with good functional and histopathological results in patients ≥75. It is therefore questionable if elderly patients can be precluded from curative radical treatment solely because of their age.
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Affiliation(s)
- Burkhard Ubrig
- 1 Department of Urology, Augusta-Kliniken Bochum , Germany .,2 Witten/Herdecke University , Witten/Herdecke, Germany
| | - Anselm Boy
- 1 Department of Urology, Augusta-Kliniken Bochum , Germany
| | - Markus Heiland
- 1 Department of Urology, Augusta-Kliniken Bochum , Germany
| | - Alexander Roosen
- 1 Department of Urology, Augusta-Kliniken Bochum , Germany .,3 Ludwig-Maximilians University , Munich, Germany
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Mandel P, Chandrasekar T, Chun FK, Huland H, Tilki D. Radical prostatectomy in patients aged 75 years or older: review of the literature. Asian J Androl 2017; 21:215663. [PMID: 28948940 PMCID: PMC6337955 DOI: 10.4103/aja.aja_43_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/20/2017] [Indexed: 12/01/2022] Open
Abstract
Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.
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Affiliation(s)
- Philipp Mandel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Thenappan Chandrasekar
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario M5G 2M9, Canada
| | - Felix K Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
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Herlemann A, Buchner A, Kretschmer A, Apfelbeck M, Stief CG, Gratzke C, Tritschler S. Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis. World J Urol 2017; 35:1517-1524. [PMID: 28493044 DOI: 10.1007/s00345-017-2045-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/02/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Gleason score upgrading should be considered when indicating surgery in prostate cancer (PCa) patients. In elderly patients, definitive treatment of low-risk PCa must be weighed with the risks of overtreatment. Our aim was to evaluate rates of Gleason score upgrading in patients ≥75 years undergoing radical prostatectomy (RP) for localized PCa and to identify predictors associated with upgrading. METHODS 3296 patients undergoing RP were retrospectively evaluated and categorized into age groups: <70 years (n = 2971) vs. ≥75 years (n = 325). We analyzed prostate-specific antigen (PSA), biopsy counts, Gleason score, pathologic T- and N-stage, and surgical margin. Propensity score matching was performed to compare rates of up- and downgrading on surgical specimen using the new five-tier pathologic grading system. Logistic regression was used to identify independent predictors of upgrading. RESULTS Preoperatively, patients ≥75 years had higher PSA (8.8 vs. 7.3 ng/mL) and lower proportion of grade group 1 (Gleason score 6) at biopsy (29.2 vs. 47.9%; both p < 0.001) compared to patients <70 years. At RP, patients ≥75 years were more likely to have extraprostatic disease (50 vs. 30%) and lower rates of grade group 1 (14.1 vs. 34.8%; both p < 0.001). Postoperative downgrading was similar (15.1 vs. 19.5%). However, patients ≥75 years had higher rates of postoperative upgrading (46.6 vs. 27.9%; p < 0.001). Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were associated with upgrading. CONCLUSIONS Patients ≥75 years not only demonstrated higher rates of advanced disease but more frequent upgrading on RP specimen. Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were predictive for upgrading. The increased risk of upgrading should be taken into consideration when discussing optimal treatment for this specific cohort.
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Affiliation(s)
- Annika Herlemann
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefan Tritschler
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Mandel P, Kriegmair MC, Kamphake JK, Chun FKH, Graefen M, Huland H, Tilki D. Tumor Characteristics and Oncologic Outcome after Radical Prostatectomy in Men 75 Years Old or Older. J Urol 2016; 196:89-94. [PMID: 26796415 DOI: 10.1016/j.juro.2016.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE As life expectancy increases, oncologic outcome in elderly patients 75 years old or older is a salient topic requiring further investigation. MATERIALS AND METHODS We analyzed the records of 13,997 patients who underwent radical prostatectomy from 2006 to 2013. Known prognosticators were compared according to age at radical prostatectomy in 13,732 patients younger than 75 years vs 265 patients 75 years old or older. Univariate and multivariate Cox regressions were used to estimate the impact of age on biochemical recurrence-free, metastasis-free, cancer specific and overall survival. RESULTS Median followup was 47.3 months. Compared to patients younger than 75 years those 75 years old or older had a higher pathological Gleason score (p <0.001) and were more likely to harbor a nonorgan confined tumor (p <0.001), have a positive surgical margin (p = 0.004) and positive lymph nodes (p = 0.028), and receive salvage androgen deprivation therapy (p = 0.002). Five-year biochemical recurrence-free, metastasis-free, cancer specific and overall survival rates were 64.2%, 84.7%, 98.4% and 91.3% in patients 75 years old or older, and 76.9%, 96.2%, 99.0% and 96.2%, respectively, in patients younger than 75 years. On univariate and multivariate analysis age 75 years or greater was associated with worse biochemical recurrence-free and metastasis-free survival. Patients 75 years old or older were more likely to die of other causes than cancer. Nevertheless, noncancer related mortality was low. CONCLUSIONS Older patients who underwent radical prostatectomy had more advanced disease. Age itself is an independent predictor of worse biochemical recurrence-free and metastasis-free survival. Healthy and highly selected patients 75 years old or older in our sample showed good long-term overall survival. Therefore, older age in well selected men should not be a contraindication to radical prostatectomy, especially in patients harboring high risk disease.
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Affiliation(s)
- Philipp Mandel
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Janneke Kleine Kamphake
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy – A propensity score matched study. Eur J Surg Oncol 2015; 41:837-43. [DOI: 10.1016/j.ejso.2015.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/17/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022] Open
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Soumarová R, Homola L, Perková H. Long term results of HDR brachytherapy in men older than 75 with localized carcinoma of the prostate. Rep Pract Oncol Radiother 2012; 18:11-5. [PMID: 24381742 DOI: 10.1016/j.rpor.2012.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 07/11/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Prostate cancer is an illness with a high incidence, especially among older men. The choice of a treatment option among men above 75 years is, however, not clear. Radical prostatectomy in this age group is connected with a relatively high morbidity. A further possibility of curative treatment is radiotherapy which can be administered in the form of external beam or in combination with high dose rate (HDR) brachytherapy. AIM The aim of our work was to evaluate how HDR brachytherapy is tolerated among men older than 75 and how associated diseases can influence the tolerance to this treatment. Of interest to us were the treatment results and mortality from other diseases. MATERIALS AND METHODS We analyzed a sample of 20 men above 75 years old (median 77 years) who were undergoing treatment by a combination of external radiotherapy and brachytherapy. Sixteen (80%) of them had prostate cancer with an intermediate and high risk of recurrence, four had low risk prostate cancer. Most patients, 14 (70%), had less than two comorbidities. RESULTS The median observation period was 57 months. No perioperative complications were recorded. Acute genitourinary toxicity (GU) to a maximum grade of 1-2 manifested in 60% of cases. Acute gastrointestinal toxicity (GIT) was observed only at grade 1 and in 25% of cases. Late GU toxicity occurred in 35% of patients, with only one showing grade 3; late GIT toxicity was recorded at grade 1 only in 3 patients (15%). 70% of the men lived longer than 3 years after treatment, at present, 50% lived more than 5 years. Long-term biochemical remission was achieved in 18 patients (90%). CONCLUSIONS HDR BRT is possible and well-tolerated in older men above 75 years in good condition and without serious intercurrence. Well-selected older patients with higher-risk tumours and without serious comorbidities undoubtedly benefit from radical treatment when compared with watchful waiting.
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Affiliation(s)
- Renata Soumarová
- Cancer Centre, Department of Radiotherapy and Oncology, Nový Jičín, Czech Republic ; Medical Faculty, Ostrava University, Czech Republic
| | - Luboš Homola
- Cancer Centre, Department of Radiotherapy and Oncology, Nový Jičín, Czech Republic
| | - Hana Perková
- Cancer Centre, Department of Radiotherapy and Oncology, Nový Jičín, Czech Republic
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Porres D, Pfister D, Labanaris A, Zugor V, Witt J, Heidenreich A. Roboterassistierte radikale Prostatektomie beim älteren Patienten. Urologe A 2012; 51:1424-31. [DOI: 10.1007/s00120-012-2925-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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