title: Poor overall survival in septa- and octogenarian patients after radical prostatectomy and radiotherapy for prostate cancer: a population-based study of 6183 men.
abstract: OBJECTIVE
  The life expectancy of candidates for attempted curative therapy of prostate cancer should not be inferior to 10 yr. We examined the rate of 10-yr survival in septa- and octogenarians treated for prostate cancer with either attempted curative external beam radiotherapy (EBRT) or radical prostatectomy (RP).
  
  
  METHODS
  Within a population-based cohort of 17,570 EBRT or RP patients, 6183 men aged 70 yr or older were treated with either RP (n=1591) or EBRT (n=4592) and represented the focus of crude survival analyses. Age and Charlson Comorbidity Index represented covariates. To control for prostate cancer-specific mortality, we repeated the analyses in a subset of 2704 men (RP, n=881; EBRT, n=1823) who had no clinical evidence of disease relapse of prostate cancer.
  
  
  RESULTS
  Overall actuarial 10-yr survival was 38.5% (RP 59.3% vs. EBRT 30.3%, p<0.001) versus 36.5% in those without clinical evidence of disease relapse (RP 63.8% vs. EBRT 22.6%, p<0.001). In multivariate Cox regression models, EBRT was associated with a 2.1-fold (p<0.001) and 2.9-fold (p<0.001) higher risk of mortality relative to RP in all men and in men without clinical evidence of disease relapse, respectively.
  
  
  CONCLUSIONS
  Forty percent of septa- and octogenarian men who are selected for RP do not have adequate life expectancy to warrant attempted curative therapy. Even more strikingly, 70% of men who receive EBRT die before reaching the 10-yr mark. These findings may indicate the need for more stringent EBRT and RP selection criteria, if the goal is to minimise overtreatment.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis