Predictors of Prostate Cancer-Specific Mortality in Elderly Men With Intermediate-Risk Prostate Cancer Treated With Brachytherapy With or Without External Beam Radiation Therapy

Journal Article · Sat May 01 04:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.04.085· OSTI ID:21372253

Nanda, Akash ^[1]; Chen, M -H ^[2]; Moran, Brian J; Braccioforte, Michelle H ^[3]; Dosoretz, Daniel; Salenius, Sharon; Katin, Michael; Ross, Rudi ^[4]; D'Amico, Anthony V ^[5]

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1. Harvard Radiation Oncology Program, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA (United States)
2. Department of Statistics, University of Connecticut, Storrs, CT (United States)
3. Prostate Cancer Foundation of Chicago, Westmont, IL (United States)
4. 21st Century Oncology, Fort Myers, FL (United States)
5. Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA (United States)

Purpose: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for comorbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy. Methods and Materials: The study cohort comprised 1,978 men of median age 71 (interquartile range, 66-75) years with intermediate-risk disease (Gleason score 7, prostate-specific antigen (PSA) 20 ng/mL or less, tumor category T2c or less). Fine and Gray's multivariable competing risks regression was used to assess whether prevalent cardiovascular disease (CVD), age, treatment, year of brachytherapy, PSA level, or tumor category was associated with the risk of PCSM. Results: After a median follow-up of 3.2 (interquartile range, 1.7-5.4) years, the presence of CVD was significantly associated with a decreased risk of PCSM (adjusted hazard ratio, 0.20; 95% CI 0.04-0.99; p = 0.05), whereas an increasing PSA level was significantly associated with an increased risk of PCSM (adjusted hazard ratio 1.14; 95% CI 1.02-1.27; p = 0.02). In the absence of CVD, cumulative incidence estimates of PCSM were higher (p = 0.03) in men with PSA levels above as compared with the median PSA level (7.3 ng/mL) or less; however, in the setting of CVD there was no difference (p = 0.27) in these estimates stratified by the median PSA level (6.9 ng/mL). Conclusions: In elderly men with intermediate-risk prostate cancer, CVD status is a negative predictor of PCSM and affects the prognostic capacity of pretreatment PSA level. These observations support the potential utility of prerandomization stratification by comorbidity to more accurately assess prognostic factors and treatment effects within this population.

• OSTI ID: 21372253
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 77; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ADULTS
AGE GROUPS
AGED ADULTS
ANIMALS
ANTIGENS
BODY
BRACHYTHERAPY
CARDIOVASCULAR DISEASES
DISEASES
ELDERLY PEOPLE
GLANDS
HUMAN POPULATIONS
MALE GENITALS
MAMMALS
MAN
MEDICINE
MINORITY GROUPS
MORTALITY
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
POPULATIONS
PRIMATES
PROSTATE
RADIOLOGY
RADIOTHERAPY
THERAPY
VERTEBRATES