Outcomes of patients older than 75 years with non-metastatic prostate cancer

Objective:Prostate cancer in elderly patients was formerly treated with androgen deprivation therapy.Since the latter of the 1990s new technologies were introduced into treatments,then strategies have varied.We aimed to observe the outcomes of elderly patients treated during transition period and compare each stage with others.Methods:During 2008 and 2010,255 patients with prostate cancer older than 75 years were sequentially treated.With exception of patients with bone and/or visceral metastasis,outcomes of 199 patients with localized and locally advanced stages were examined.Complete records were obtained by the end of 2015.Results:In total,122(61%),28(14%),37(19%)and 12(6%)of patients were in stages T1c-T2a,T2b-c,T3 and T4,respectively.Patients generally presented with abnormal screening or lower urinary tract symptom.Seventy-one percent of patients received androgen deprivation therapy as monotherapy and 22% of the radiation-treated patients added androgen deprivation therapy.Patients in stage T1c-T2a and T2b-c showed a favorable prognosis.Some cancer death appeared in patients with T3 and T4 during observation periods.Twenty-seven percent of patients died from prostate cancer-independent complications:pneumonia,heart disease,and brain vascular disease.Tendency is similar to that of Japanese elderly male population.No remarkable side effects from androgen deprivation therapy were noticed.

Treatment strategy for metastatic prostate cancer with extremely high PSA level： reconsidering the value of vintage therapy

The prognostic significance of initial prostate-specific antigen （PSA） level for metastatic prostate cancer remains uncertain. We investigated the differences in prognosis and response to hormonal therapies of metastatic prostate cancer patients according to initial PSA levels. We analyzed 184 patients diagnosed with metastatic prostate cancer and divided them into three PSA level groups as follows： low （〈100 ng ml-1）, intermediate （100–999 ng ml-1）, and high （≥1000 ng ml-1）. All patients received androgen deprivation therapy （ADT） immediately. We investigated PSA progression-free survival （PFS） for first-line ADT and overall survival （OS） within each of the three groups. Furthermore, we analyzed response to antiandrogen withdrawal （AW） and alternative antiandrogen （AA） therapies after development of castration-resistant prostate cancer （CRPC）. No significant differences in OS were observed among the three groups （P = 0.654）. Patients with high PSA levels had significantly short PFS for first-line ADT （P = 0.037）. Conversely, patients in the high PSA level group had significantly longer PFS when treated with AW than those in the low PSA level group （P = 0.047）. Furthermore, patients with high PSA levels had significantly longer PFS when provided with AA therapy （P = 0.049）. PSA responders to AW and AA therapies had significantly longer survival after CRPC development than nonresponders （P = 0.011 and P 〈 0.001, respectively）. Thus, extremely high PSA level predicted favorable response to vintage sequential ADT and AW. The current data suggest a novel aspect of extremely high PSA value as a favorable prognostic marker after development of CRPC.