Outcomes of Radical Radiotherapy in Prostate Cancer Patients Over 80 Years of Age

TL;DR

This study examines the effectiveness of radical radiotherapy in prostate cancer patients over 80 years old, finding it can lead to good survival outcomes despite high-risk disease.

Contribution

The study provides new insights into treatment outcomes for elderly prostate cancer patients using radical radiotherapy, a group with limited prior data.

Findings

Five-year biochemical recurrence-free survival was 77% in patients over 80 treated with radical radiotherapy.

21% of deaths in these patients were attributed to prostate cancer despite treatment.

High-risk disease patients showed clinically meaningful survival benefits from radical radiotherapy.

Abstract

Background

Despite advances in surgery, radiotherapy, and systemic therapies, treatment selection and sequencing remain major challenges in optimizing outcomes for patients with prostate cancer. Men aged 50-69 years with screen-detected disease often achieve favorable outcomes across various treatment strategies, whether managed with active monitoring, prostatectomy, or radical radiotherapy. However, limited information is available on outcomes in older patients. This study retrospectively evaluates survival outcomes in older patients treated with radical radiotherapy at a tertiary UK cancer center.

Methods

At Clatterbridge Cancer Centre NHS Foundation Trust, the electronic health records system was used to identify patients aged 80 years or older who received radical radiotherapy over a five-year period, with at least five years of follow-up. Demographic data collected included disease risk profile and comorbidities. Biochemical recurrence-free survival (BFS), metastasis-free survival (MFS), hormone-free survival (HFS), and overall survival (OS) were analyzed.

Results

Between January 2013 and December 2017, 82 patients were treated and analyzed. The median age was 81 years, and most patients had a performance status of 0 or 1 with minimal significant comorbidities. Prostate cancer was classified as high or very high risk (National Comprehensive Cancer Network) in 88% of patients. Five-year BFS, MFS, HFS, and OS were 77%, 88%, 86%, and 77%, respectively. Despite receiving radical radiotherapy, 21% of deaths were attributable to prostate cancer.

Conclusions

Prostate cancer patients aged 80 years or older treated with radical radiotherapy can achieve favorable BFS and HFS despite high-risk disease. These outcomes are clinically meaningful, as untreated disease may lead to worsening symptoms and the future need for lifelong hormone therapy with its associated toxicities. Nonetheless, a substantial proportion of patients will die from the disease despite receiving radical radiotherapy.

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