Abstract：
Elderly men are underrepresented in prostate cancer (PCa) literature, with management based on individualized care pathways and life expectancy. Reports have shown survival benefit with radiation (XRT), surgery, and hormone (ADT) in localized disease. The objective of this study was to assess treatment trends and overall survival (OS) among men 75 years of age and older with cT1c PCa.
The National Cancer Database was queried to identify patients with cT1c PCa, aged 75 years and older, between 2004 and 2016. We excluded individuals with N1/NX or M1/MX disease, unknown treatment, treatment with both XRT and surgery, surgery other than radical prostatectomy (RP), or PSA > 10 ng/ml. We described 4 treatment cohorts: observation, XRT, surgery, and ADT alone. Treatment trends and OS were analyzed using SPSS.
Among 49,843 patients, 7% had surgery, 66% had XRT, 5% had ADT alone, and 22% were observed. From 2004-2016, a large decline in XRT was noted, with an increase in surgery and observation. Men receiving ADT alone were significantly older, with higher Gleason\'s score, and lower incomes. Cox regression revealed survival benefit for surgery and XRT (HR 0.44 and 0.69, P < .001 respectively); ADT had worse survival than observation (HR 1.23, P < .001).
Fewer men 75 years of age and older with cT1c PCa are being diagnosed and treated. Rates of XRT have declined, with rises in surgery and observation. Survival benefit was seen for surgery and XRT among elderly men, which highlights the importance of proper patient selection for improved outcomes in a highly individualized sphere.
The National Cancer Database was queried to identify patients with cT1c PCa, aged 75 years and older, between 2004 and 2016. We excluded individuals with N1/NX or M1/MX disease, unknown treatment, treatment with both XRT and surgery, surgery other than radical prostatectomy (RP), or PSA > 10 ng/ml. We described 4 treatment cohorts: observation, XRT, surgery, and ADT alone. Treatment trends and OS were analyzed using SPSS.
Among 49,843 patients, 7% had surgery, 66% had XRT, 5% had ADT alone, and 22% were observed. From 2004-2016, a large decline in XRT was noted, with an increase in surgery and observation. Men receiving ADT alone were significantly older, with higher Gleason\'s score, and lower incomes. Cox regression revealed survival benefit for surgery and XRT (HR 0.44 and 0.69, P < .001 respectively); ADT had worse survival than observation (HR 1.23, P < .001).
Fewer men 75 years of age and older with cT1c PCa are being diagnosed and treated. Rates of XRT have declined, with rises in surgery and observation. Survival benefit was seen for surgery and XRT among elderly men, which highlights the importance of proper patient selection for improved outcomes in a highly individualized sphere.
摘要：
背景：老年男性在前列腺癌（PCa）文献中的代表性不足，基于个性化护理途径和预期寿命的管理。报告显示放疗（XRT）对生存有益，手术,和激素（ADT）在局部疾病。这项研究的目的是评估75岁及以上患有cT1cPCa的男性的治疗趋势和总生存期（OS）。
方法：查询国家癌症数据库以确定患有cT1cPCa的患者，75岁及以上，2004年至2016年。我们排除了N1/NX或M1/MX疾病的个体，未知的治疗,XRT和手术治疗，前列腺癌根治术（RP）以外的手术，或PSA>10ng/ml。我们描述了4个治疗队列：观察，XRT,手术,只有ADT。使用SPSS分析治疗趋势和OS。
结果：在49,843名患者中，7%做了手术,66%有XRT,5%单独有ADT，和22％的观察。从2004年到2016年，XRT大幅下降，随着手术和观察的增加。单独接受ADT的男性年龄明显较大，Gleason的分数更高,和较低的收入。Cox回归显示手术和XRT的生存获益（HR分别为0.44和0.69，P<.001）；ADT的生存比观察差（HR1.23，P<.001）。
结论：接受诊断和治疗的75岁及以上的cT1cPCa男性较少。XRT的价格已经下降，随着手术和观察的上升。在老年男性中，手术和XRT的生存获益明显，这突出了在高度个性化领域中正确选择患者以改善预后的重要性。
方法：查询国家癌症数据库以确定患有cT1cPCa的患者，75岁及以上，2004年至2016年。我们排除了N1/NX或M1/MX疾病的个体，未知的治疗,XRT和手术治疗，前列腺癌根治术（RP）以外的手术，或PSA>10ng/ml。我们描述了4个治疗队列：观察，XRT,手术,只有ADT。使用SPSS分析治疗趋势和OS。
结果：在49,843名患者中，7%做了手术,66%有XRT,5%单独有ADT，和22％的观察。从2004年到2016年，XRT大幅下降，随着手术和观察的增加。单独接受ADT的男性年龄明显较大，Gleason的分数更高,和较低的收入。Cox回归显示手术和XRT的生存获益（HR分别为0.44和0.69，P<.001）；ADT的生存比观察差（HR1.23，P<.001）。
结论：接受诊断和治疗的75岁及以上的cT1cPCa男性较少。XRT的价格已经下降，随着手术和观察的上升。在老年男性中，手术和XRT的生存获益明显，这突出了在高度个性化领域中正确选择患者以改善预后的重要性。
