Can Comprehensive Geriatric Assessment Predict Tolerance of Radiotherapy for Localized Prostate Cancer in Men Aged 75 Years or Older?

Abstract

Curative radiotherapy for prostate cancer is common in the elderly. However, concerns about potential toxicity have inhibited access to radiotherapy for this population, for whom preserving quality of life (QoL) is crucial. The primary endpoint was to identify predictors of impaired QoL in men aged 75 years or older treated with curative intent radiotherapy with or without androgen deprivation therapy (ADT) for localized prostate cancer. We prospectively performed comprehensive geriatric assessment (CGA) and administered QoL questionnaires to 208 elderly (>75 years) patients prior to, plus two and six months after, radiotherapy (NCT 02876237). The median age of the patients was 77 years (range 75–89). At the start of the study, comorbidities were highlighted in 65% of patients: 23% were depressed, 23% had cognitive impairment, and 16% had reduced independence. At six months, 9% of patients had a consistently decreased QoL (>20 points), and a further 16% had a more moderate reduction (10 to 20 points) in QoL. None of the parameters studied (tumor characteristic, treatment, or oncogeriatric parameters) were predictive of a reduced QoL following radiotherapy. Though co-existing geriatric impairment was common, QoL was maintained for 75% of patients six months after radiotherapy. CGA was poorly predictive of tolerance of prostatic radiotherapy. Geriatric assessments dedicated to quality of life following radiotherapy need to be developed.

The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study

“…However, illness perception and vitality were better, which corresponds to the positive association between age and hormonal/vitality scores found in the present study [32]. Taking studies including only older men into account, mainly stable QoL as measured by the QLQ-C30 and SF-36 after radical treatment is reported [18,33], but declining functional independence has also been found [15]. Thus, results are not consistent, and comparison between studies is also hampered by differences in patient cohorts, study design, timing of assessment and assessment tools.…”

“…Moreover, the overall results regarding the impact of age at treatment are not consistent. There are several reports that older men may fare worse, in particular with respect to some local side effects [15][16][17], but others have found that functioning and QoL are mainly preserved [18][19][20][21]. Thus, for patient information and shared decision making, there is a need for more knowledge on how this older group tolerates curative prostate cancer treatment, in particular as their number is likely to increase due to an ageing population.…”

Irradiation of localized prostate cancer in the elderly: A systematic literature review

“…If the primary objective of a treatment is to improve prognosis, it must not be deleterious and burden the QoL, especially in the elderly, who may have multiple comorbidities already impacting their daily condition. Goineau et al prospectively explored the different predictive factors of QoL deterioration in a cohort of 208 pts ≥ 75y (MA 77y) with localized PC (mainly intermediate- or high-risk) treated with EBRT ± ADT (>50% had comorbidities) [42] . The authors observed that tolerance was good with QoL maintained in 75% of patients (severe loss in 8.8%).…”

“…The authors observed that tolerance was good with QoL maintained in 75% of patients (severe loss in 8.8%). Unfortunately, none of the parameters analyzed were considered predictive factors for QoL deterioration (oncogeriatric assessment, tumor and treatment characteristics (ADT, pelvic field, operating field) with a view to identifying patients potentially at risk [42] .…”

High-dose-rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort

“…Indeed, retrospective studies discussed the benefit of the combination EBRT + ADT for older adults with moderate/severe comorbidities or the super-aged, highlighting the importance of oncogeriatric assessment [40,41]. In a prospective study, Goineau et al [42] analyzed quality of life (QoL) in 208 pts ≥ 75 y with localized PC treated after EBRT+/-ADT (without BT boost). The authors reported that, compared to baseline results, QoL was not significantly different in 75% of the pts.…”