Prostate Cancer And Quality Of Life Outcomes In Men 75 Years And Older Treated By Permanent Prostate Brachytherapy (Ppb)

To determine the benefit and morbidity of treating older men with PPB. Of 2111 prostate cancer patients treated by PPB, 267 (12.6%) were ≥ 75 years old (median 77, range 75-88, O). The 1844 younger patients (median 65 years, range 39-74, Y) were compared to the older patients for PSA failure (BFFF, Phoenix definition), overall survival (OS) and cause specific survival (CSS). Quality of life comparisons were made for urinary retention (UR), change between pre-implant and last follow-up AUA symptom score (dIPSS), incontinence (I), erectile dysfunction (ED) and rectal bleeding (RB). Patients were followed a median of 6 years (range 2-17). O patients had higher Gleason score (GS, p<0.001), stage (p<0.001) and PSA (mean 9.6 vs. 11.3 ng/ml, p = 0.04)). Radiation dose, calculated from the post-implant dosimetry was the same for each group. Survival functions were determined by Kaplan Meier method and Cox regression. Proportions were tested by Chi-square (Pearson). Means were compared by student t test and ANOVA. The 10 year BFFF was 82.3% (Y) vs. 84.2% (O). For low, intermediate and high risk disease the 10 year BFFF were 87.7% vs 96.2% (p = 0.57), 86% vs. 94.1% (p = 0.31) and 71.2% vs. 70.7% (p = 0.26), respectively. OS was 83.2 (Y) vs. 56.7% (O, p<0.001). CSS was 97% (Y) vs. 90% (O, p = 0.001). Cox regression revealed age for OS (p<0.001) and for CSS age (p = 0.012), GS (p<0.001) and radiation dose (p = 0.03) as significant. The risk of dying from prostate cancer was 2.95 times greater (95% CI 1.4-6.2, p = 0.003) for the older men. UR was 7% (Y) vs. 9.7% (O, p = 0.117). dIPSS did not differ between the two (2.3 (Y) vs, 3.0 (O), p = 0.169). I was increased in O: 6.7% vs. 3.3%, OR 2.11 (95% CI 1.2-3.6, p = 0.006). ED was also increased in O: 79% vs. 45.3%, p<0.001. 75.4% of the O men had hormonal therapy (HT) vs. 52.7% of Y (p<0.001). The median time on HT was the same for each group (6.5 months). ED incidence was the same for those without HT. There was no difference in RB: 4.1% (O) vs. 5.2% (Y), p = 0.45. Men ≥ 75 years have a greater likelihood of dying from prostate cancer than younger patients. The morbidity is higher in this age group, but not substantially enough to warrant elimination of early detection and treatment of this patient population.