Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Abstract

Androgen deprivation therapy (ADT) is used to improve overall survival (OS) in prostate cancer treatment; however, we encountered that long-term ADT in elderly patients may be related to high other-cause mortality (OCM). This study aimed to confirm the potential risk associated with long-term ADT in elderly patients using a different large cohort. A comparison analysis was conducted between the ≥2- and <2-year ADT groups using open, large data from 1840 patients with clinically localized prostate cancer treated with radiotherapy (1172 treated with high-dose-rate brachytherapy (HDR) + external beam radiotherapy (EBRT) and 668 treated with external beam radiotherapy). The OCM-free survival (OCMFS), overall survival, and prostate cancer-specific survival rates were measured. The 10-year OCMFS rates in patients aged ≥75 years were 94.6% and 86% in the <2- and ≥2-year ADT groups, respectively, but were 96.3% and 93.5% (p = 0.0006) in their younger counterparts. If dividing into HDR and EBRT groups. This inclination was found in brachytherapy group but not in EBRT group. The overall survival rate was also lower in the elderly patients in the ≥2-year ADT group than in the <2-year ADT group; however, the 10-year prostate cancer-specific survival rate was the same in both groups. Long-term ADT in elderly patients resulted in not only higher OCM rates but also poorer OS rates; therefore, longer-term ADT in elderly patients should be performed with meticulous care.

Conventional dose versus dose escalated radiotherapy including high-dose-rate brachytherapy boost for patients with Gleason score 9–10 clinical localized prostate cancer

“…However, a recent meta-analysis of trials of RT and ADT suggested that patients with Gleason score 9–10 prostate cancer had the greatest benefit from lifelong ADT, whereas the optimal treatment for those with Gleason score 8 prostate cancer might be long-term (but not lifelong) ADT 28 . We also observed that longer-term ADT use by > 2 years increases the occurrence of other causes of mortality in patients aged > 75 years 29 . Meticulous patient selection should be considered to maximize the efficacy of ADT without toxicity.…”

How socioeconomic and clinical factors impact prostate‐cancer‐specific and other‐cause mortality in prostate cancer stratified by clinical stage: Competing‐risk analysis

“…There were some limitations in this study. The first was from missing important variables, such as comorbidities, androgen deprivation therapy, and access to care, which are very important when studying PCSM and OCM 31,32 . However, these data could not be obtained due to restrictions in permissions to accessing SEER data or such data not existing in the SEER database.…”

Radiation therapy after radical prostatectomy is associated with higher other-cause mortality

“…Despite its cancer control advantage, EBRT after RP may cause toxicities. Potentially, some of long-term metabolic toxicities associated with EBRT and/or ADT may result in decreased life expectancy, due to mortality from non-PCa-related causes [8][9][10][11][12][13][14].…”