Definitive Radiation Therapy for Older Adults With Localized Prostate Cancer

Introduction Individual health and life expectancy, rather than age, should drive management decisions for patients with prostate cancer. There is limited available data regarding treatment outcomes and tolerance for older adults where health status warranted treatment with curative intent. Herein, we report treatment outcomes for patients 80 years and older who received definitive radiation therapy (RT) for localized prostate cancer. Methods This retrospective study includes 41 patients who received RT for localized prostate cancer at the age of 80 years or older between 2004 and 2022. The median age was 83. Baseline details and outcomes, including treatment toxicity, symptom scores, biochemical recurrence (BR), distant metastases (DM), and overall survival (OS), were collected in a secure database and analyzed with Graphpad Prism (GraphPad Software, Boston, MA, USA) and R software (version 4.5; R Foundation for Statistical Computing, Vienna, Austria). Results No patients experienced adverse events that were Common Terminology Criteria for Adverse Events (CTCAE) grade 4 or higher. One patient (2.4%) experienced late CTCAE grade 3 proctitis, seven patients (17.1%) experienced acute CTCAE grade 2 genitourinary adverse events (GU AE), and five patients (12.2%) experienced late grade 2 GU AEs. Mean urinary symptom scores improved after RT (with the International Prostate Symptom Score (IPSS) decreasing from 12.1 pre-RT to 8.2 post-RT). The estimated four-year cumulative incidence of metastases was 6.7% (95% CI 0-16.1%). There were trends in outcomes based on risk group, but no statistically significant differences between intermediate risk cancer (IR) and high or very high-risk cancer (HR/VHR) regarding BF (15% vs. 20%, p=0.17), DM (0% vs. 10%, p=0.20), or OS (94% vs. 96%, p=0.38). Conclusions Definitive RT for patients 80 years or older was generally well tolerated and effective in this small cohort. These findings may indicate a favorable risk/benefit ratio for definitive prostate cancer treatment for select patients 80 years or older. Decision-making for prostate cancer treatment should involve a comprehensive approach, accounting for each individual patient's life expectancy and overall health rather than avoidance of treatment based simply on age.