The Latest Data Specifically Focused on Long‐Term Oncologic Prognostication for Very Old Adults with Acute Vulnerable Localized Prostate Cancer: A Nationwide Cohort Study

Purpose: Few studies have evaluated the prime treatment choice for men older than 80 years with acute vulnerable localized prostate cancer (AV‐LPC). Clinicians have been deeply troubled by this near end‐of‐life medical choice for a very specific group of patients. We compared the oncological prognostication of very old patients with AV‐LPC after they underwent either radical prostatectomy (RP) or massive‐dose intensity‐modulated radiotherapy (IMRT) coupled with long-term androgen deprivation therapy (ADT) over a long‐term investigation. Methods: In this nationwide cohort study, we used the Taiwan Cancer Registry Database and retrieved information related to patients (aged ≥80 years) with AV‐LPC who underwent standard RP (the RP group) or massivedose IMRT + long‐term ADT (at least 72 Gy and ADT use ≥18 months; the IMRT + ADT group). After potential confounders were controlled for using propensity score matching (PSM), we utilized the Cox proportional hazards regression to evaluate the oncologic prognostication. Results: The IMRT + ADT group had a significantly higher adjusted hazard ratio (aHR) for all‐cause mortality (aHR, 2.00; 95% confidence interval [CI], 1.41–2.87) than the RP group. Analysis of the secondary outcomes revealed that compared with the RP group, the aHRs of biochemical failure, locoregional recurrence, and distant metastasis in the IMRT + ADT group were 1.77 (95% CI: 1.36–2.11, p < 0.0001), 1.12 (95% CI: 1.04–1.33, p < 0.0001), and 1.15 (95% CI: 1.06–1.71, p = 0.0311), respectively. Conclusion: RP provides more favorable oncological prognostication than IMRT in very old adults with AV‐LPC.