title: Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians.
abstract: BACKGROUND
  Brachytherapy (BT) is a widely used treatment modality for elderly patients with localized prostate cancer (PCa).
  
  
  OBJECTIVE
  To describe the patterns of BT use in octo- and nonagenarians treated for localized PCa in the USA. We hypothesized that most individuals treated with BT should remain alive for at least 10 years. We also postulated that BT should ideally be administered as monotherapy.
  
  
  METHODS
  Using the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, 2701 octo- and nonagenarians treated with BT between 1992 and 2009 were identified. Cumulative incidence rates and smoothed cumulative incidence plots were used.
  
  
  RESULTS
  In patients with low-risk characteristics, 40 % received BT alone; 27 % received BT combined with ADT; 19 % received BT and EBRT; and 14 % received BT combined with both ADT and EBRT. Of intermediate-to-high-risk patients, 19 % received BT alone; 16 % received BT combined with ADT; 19 % received BT combined with EBRT; and 45 % received BT together with ADT and EBRT. Overall survival rate was 79 and 47 % at 5 and 10 years.
  
  
  CONCLUSIONS
  Less than half of elderly treated with BT remain alive at 10 years of follow-up. Moreover, the vast majority of those individuals not only receives BT, but is also exposed to two or even three combined therapy modalities. These findings are worrisome.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors: Roger
authors: R
authors: Valdivieso
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. boehm@martini-klinik.de.|Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. boehm@martini-klinik.de.
authors: Katharina
authors: K
authors: Boehm
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors: Malek
authors: M
authors: Meskawi
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Alessandro
authors: A
authors: Larcher
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
authors: Zhe
authors: Z
authors: Tian
authors: INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique, Laval, QC, Canada.|University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
authors: Marie-Elise
authors: ME
authors: Parent
authors: Department of Radiation Oncology, University of Montreal Health Center, Montreal, QC, Canada.
authors: Philip
authors: P
authors: Wong
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Markus
authors: M
authors: Graefen
authors: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
authors: Maxine
authors: M
authors: Sun
authors: Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors: Fred
authors: F
authors: Saad
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001918:Brachytherapy; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D018426:SEER Program; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Brachytherapy; Elderly patients; Localized prostate cancer; Octo- and nonagenarians; Prostate cancer; Survival