Abstract
Background
Prostate Cancer (PCa) is the second leading cause of cancer death in the elderly (≥75 years). There is currently little data on hypofractionated radiotherapy in older patients affected by localized PCa. We present the long-term results of hypofractionated radiotherapy in elderly patients with localized PCa from the IPOPROMISE database.
Materials and Methods
retrospective analysis of 719 PCa elderly (≥75 years) patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020. For survival endpoints, we used Kaplan-Meier survival curves and univariate and multivariable Cox’s proportional hazards regression models.
Results
Median age at PCa diagnosis was 78.4 years (interquartile [IQR], 76.8–80.3 years), 74% of patients had a modified Charlson co-morbidity index (elderly-PCa-CCI, (e-PCCI)) of 0. Based on NCCN risk grouping, 399 patients (55.5%) were affected by unfavorable to very high-risk disease. Median follow-up was 4.2 years (IQR 2.4–6.4 years). 31/719 (4.3%) patients died from any cause. At 5 years, overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival were 95.6% (95% CI 93.4–97.1%), 99.2% (95%CI 97.9–99.7%), and 97.3% (95% CI 95.1–98.5%), respectively. In multivariate analysis, baseline PSA, and Gleason score were associated with MFS. On univariate analysis, e-PCCI ≥ 2 was associated with OS (p = 0.02). The 5-year freedom from late grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity were 95.1% (95% CI 93.0–96.5%) and 96.7% (95% CI 93.7–97.1%), respectively.
Conclusions
Our results represent a valuable add-on to the current literature, confirming the prominent role of radiotherapy in the cure of elderly fit patients affected by localized disease.
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Data availability
The data supporting this study’s findings are available from the corresponding author, GI, upon reasonable request.
References
Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74:12–49.
Lancia A, Ingrosso G, Carosi A, Bottero M, Cancelli A, Turturici I, et al. Oligometastatic cancer in elderly patients: the “blitzkrieg” radiotherapy approach: SBRT in oligometastatic elderly patients. Aging Clin Exp Res. 2019;31:109–14.
Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, et al. Hypofractionated radiation therapy for localized prostate cancer: An ASTRO, ASCO, and AUA Evidence-Based Guideline. J Clin Oncol. 2018;36:JCO1801097.
Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021;79:243–62.
Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, et al. Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol. 2017;35:1884–90.
Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016;17:1047–60.
Lee WR, Dignam JJ, Amin MB, Bruner DW, Low D, Swanson GP, et al. Randomized Phase III Noninferiority study comparing two radiotherapy fractionation schedules in patients with low-risk prostate cancer. J Clin Oncol. 2016;34:2325–32.
Ingrosso G, Ponti E, Francolini G, Caini S, Fondelli S, Santini R, et al. Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE). Radio Med. 2024;129:643–52.
Roach M 3rd, Hanks G, Thames H Jr, Thames H Jr, Schellhammer P, Shipley WU, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65:965–74.
Wilson JM, Dearnaley DP, Syndikus I, Khoo V, Birtle A, Bloomfield D, et al. The efficacy and safety of conventional and hypofractionated high-dose radiation therapy for prostate cancer in an elderly population: a subgroup analysis of the CHHiP trial. Int J Radiat Oncol Biol Phys. 2018;100:1179–89.
Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, et al. Outcomes of localized prostate cancer following conservative management. JAMA. 2009;302:1202–9.
Dell’Oglio P, Boehm K, Trudeau V, Tian Z, Larcher A, Leyh-Bannurah SR, et al. Survival after conservative management versus external beam radiation therapy in elderly patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2016;96:1037–45.
Wilt TJ, Vo TN, Langsetmo L, Dahm P, Wheeler T, Aronson WJ, et al. Radical prostatectomy or observation for clinically localized prostate cancer: extended follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol. 2020;77:713–24.
Bokhorst LP, Valdagni R, Rannikko A, Kakehi Y, Pickles T, Bangma CH, et al. A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment. Eur Urol. 2016;70:954–60.
Bratt O, Folkvaljon Y, Hjälm Eriksson M, Akre O, Carlsson S, Drevin L, et al. Undertreatment of men in their seventies with high-risk nonmetastatic prostate cancer. Eur Urol. 2015;68:53–8.
Lu-Yao GL, Albertsen PC, Moore DF, Lin Y, DiPaola RS, Yao SL. Fifteen-year outcomes following conservative management among men aged 65 years or older with localized prostate cancer. Eur Urol. 2015;68:805–11.
Hamilton AS, Fleming ST, Wang D, Goodman M, Wu XC, Owen JB, et al. Clinical and demographic factors associated with receipt of non guideline-concordant initial therapy for nonmetastatic prostate cancer. Am J Clin Oncol. 2016;39:55–63.
Fung C, Dale W, Mohile SG. Prostate cancer in the elderly patient. J Clin Oncol. 2014;32:2523–30.
Yang DD, Mahal BA, Muralidhar V, Boldbaatar N, Labe SA, Nezolosky MD, et al. Receipt of definitive therapy in elderly patients with unfavorable-risk prostate cancer. Cancer. 2017;123:4832–40.
Akre O, Garmo H, Adolfsson J, Lambe M, Bratt O, Stattin P. Mortality among men with locally advanced prostate cancer managed with noncurative intent: a nationwide study in PCBaSe Sweden. Eur Urol. 2011;60:554–63.
Daskivich TJ, Luu M, Heard J, Thomas IC, Leppert JT. Overtreatment of prostate cancer among men with limited longevity in the active surveillance era. JAMA Intern Med. 2024;11:e245994.
Dalla Volta A, Palumbo C, Zamboni S, Mazziotti G, Triggiani L, Zamparini M, et al. Heterogeneity in regional changes in body composition induced by androgen deprivation therapy in prostate cancer patients: potential impact on bone health-the BLADE study. J Endocrinol Invest. 2024;47:335–43.
Tully KH, Nguyen DD, Herzog P, Jin G, Noldus J, Nguyen PL, et al. Risk of dementia and depression in young and middle-aged men presenting with nonmetastatic prostate cancer treated with androgen deprivation therapy. Eur Urol Oncol. 2021;4:66–72.
Eurostat Statistics Explained. 2024 Nov 10. Available from https://ec.europa.eu/eurostat/statistics-explained.
European Cancer Information System. 2024 Nov 10. Available from https://ecis.jrc.ec.europa.eu.
Roussel B, Ouellet GM, Mohile SG, Dale W. Prostate cancer in elderly men: screening, active surveillance, and definitive therapy. Clin Geriatr Med. 2015;31:615–29.
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GI, AL, BD, EP, contributed to the study conception and design. EF, SC, CD, GF, MV, LR, contributed to the material preparation. SF, RS, AB, AA, FT, DR, MT, SP, SB, SG, SS, DM, MS, GFa, TS, GM, BS, ADM, RB, AV, contributed to data collection and analysis. LV, CA, GI, BD, AL, SC, CD contributed to the draft of the manuscript. All authors read and approved the final manuscript.
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This study was performed following the principles of the Declaration of Helsinki. Approval was granted by the Ethical Committee of Regione Umbria (Approval N. 25991/22/ON, 26/10/2022). Informed consent was obtained from all individual participants included in the study. Every human participant provided informed consent.
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Ingrosso, G., Festa, E., Caini, S. et al. Hypofractionated radiotherapy in elderly patients (≥75 years) affected by localized prostate cancer: a multicenter retrospective analysis from the IPOPROMISE study. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-00962-z
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DOI: https://doi.org/10.1038/s41391-025-00962-z
