Impact of Androgen Deprivation Therapy Associated to Conformal Radiotherapy in the Treatment of D’Amico Intermediate-/High-Risk Prostate Cancer in Older Patients
by
,
Anne-Laure Couderc
1,2,*
,
Emanuel Nicolas
3,4,
Romain Boissier
2,5,
Mohammed Boucekine
6,
Cyrille Bastide
2,7,
Delphine Badinand
8,
Dominique Rossi
2,7,
Benedicte Mugnier
1,
Patrick Villani
1,2,
Gilles Karsenty
2,5,
Didier Cowen
2,8,
Eric Lechevallier
2,5 and
Xavier Muracciole
8 1
Internal Medicine, Geriatric and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), and Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France
2
Medical School, Aix-Marseille University, 13005 Marseille, France
3
Department of Medical Oncology, University Hospital of Nimes, 30000 Nimes, France
4
IDESP Institute Desbrest of Epidemiology and Public Health, Research Unit INSERM, University of Montpellier, 34000 Montpellier, France
5
Urology Department, Conception Hospital, AP-HM, 13005 Marseille, France
6
Department of Public Health, EA 3279 Self-Perceveid Health Assessment Research Unit, Medical School, Aix-Marseille University, 13005 Marseille, France
7
Urology Department, Nord Hospital, AP-HM, 13015 Marseille, France
8
Radiotherapy Department, La Timone Hospital, AP-HM, 13005 Marseille, France
*
Author to whom correspondence should be addressed.
Cancers 2021, 13(1), 75; https://doi.org/10.3390/cancers13010075
Submission received: 19 November 2020
/
Revised: 18 December 2020
/
Accepted: 24 December 2020
/
Published: 29 December 2020
(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)
Simple Summary
Androgen Deprivation Therapy (ADT) combined with radiotherapy is recommended for a duration of 6 months in unfavorable D’Amico intermediate-risk (IR) prostate cancer and a duration of 18 to 36 months in D’Amico high-risk (HR) prostate cancer. However, as patients ≥80 years are excluded from phase III trials combining radiotherapy and ADT, there is no consensus in this population regarding the combination of these treatments. So, we aimed to report the oncological results and morbidity radiotherapy +ADT in 101 ≥ 80 years patients with IR/HR localized prostate cancers in Marseille University Hospital. The tolerance of ADT in association to radiotherapy was acceptable in this study. There was no increase in the incidence of cardiovascular events compared to the general population, whatever the duration of ADT. The absence of significant difference in biochemical recurrence-free survival or distant metastasis-free survival between 6 and 15 months of ADT in the HR group of patients raise the question of the optimal duration of ADT in this older population. However cardio-vascular evaluation and surveillance are mandatory, especially for men over 82 years old.
Abstract
Purpose/objective: The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in ≥80 years patients. Material and Methods: From June 1998 to July 2017, 101 patients ≥80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A; n = 41) and 15 months for HR prostate cancer (group B; n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. Results: Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of ≥80 years patients with no impact on OS. In the multivariate analysis, age <82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. Conclusion: Age ≥80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory.
Keywords:
localized prostate cancer; 3D conformal external beam radiotherapy; androgen deprivation therapy; older adults
