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

ABSTRACT: 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 massive-dose 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.

SUBMITTER: Wu S

PROVIDER: S-EPMC9225393 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Project description:BackgroundPeople in very old age (VOA) are expected to be confronted with particularly negative stereotypes. These influence societally shared behavior towards and judgements about them. Such external evaluations of individuals' lives are considered a crucial part of their quality of life (QoL).ObjectiveThe present study elaborated a) the societal appreciation perceived by people in VOA and b) the stereotypes about people in VOA held by stakeholders from key societal areas. The aim was to discuss possible connections between these external standards and individual life results.Material and methodsA parallel mixed methods design was employed. Cross-sectional data from a representative survey of people aged 80 years and older (n = 1863) were analyzed by means of χ2-tests and Kruskal-Wallis tests to examine differences in perceived societal appreciation (PSA) by characteristics of the person, their biography, and current lifestyle. Linear regression models were used to investigate the impact of these characteristics on PSA. Regarding stereotypes about people in VOA, semi-structured interviews with stakeholders from key societal areas (n = 22) were analyzed using qualitative content analysis. The quantitative and qualitative findings were juxtaposed for comparison.ResultsPSA was predicted by health-related variables and productive activities. Several societal stakeholders highlighted that age-related losses pose challenges on very old individuals, their families, and society, whereas remaining potentials in VOA can and should be used for the benefit of others; however, stakeholders' perceptions differed by the extent of their professional contact with (very) old people. Different pathways were proposed through which the observed stereotypes and determinants of PSA might be connected (e.g., stereotype internalization).ConclusionOur study illustrates the relevance of external standards for individual QoL and highlights the need for a normative perspective in the discussion about QoL and its enhancement.

Project description:PurposeTo explore intraocular pressure (IOP) and its associated parameters in an aged population.MethodsThe epidemiologic Ural Very Old Study (UVOS) conducted in Bashkortostan/Russia included 1526 participants with an age of ≥85 years. Besides a whole series of ocular and systemic examinations, IOP was determined applying non-contact tonometry. Body mass index, diastolic blood pressure and age were the factors used to estimate the cerebrospinal fluid pressure (CSFP).ResultsThe study consisted of 904 participants (age: 88.6 ± 2.7 years) with available IOP readings and without anti-glaucomatous therapy. Mean IOP was 14.5 ± 5.1 mmHg (median: 14 mm Hg; Q1:11; Q3:16; 95%CI:8,25) and 14.8 ± 4.6 mmHg (median: 14 mm Hg; Q1:12; Q3:17; 95%CI:8,28) in the right and left eyes, respectively. Higher IOP correlated (multivariable analysis; correlation coefficient r2:0.32) with female sex (P < 0.001), more sedentary lifestyle (P = 0.006), higher estimated CSFP (P < 0.001), higher total protein serum concentration (P < 0.001), stronger hand grip force (P = 0.01), thicker central cornea (P < 0.001), longer axial length (P = 0.01), absence of previous cataract surgery (P = 0.001), higher degree of pseudoexfoliation (P = 0.02, and thinner peripapillary retinal nerve fiber layer thickness (P = 0.004). Using this that model, IOP reading enlarged by 0.22 mmHg (95% CI: 0.09, 0.35) for each increase in estimated CSFP by 1 mm Hg, by 0.03 mm Hg (95% CI: 0.02,0.05) for each thickening in central corneal thickness by 1 μm, by 0.56 mm Hg (95%CI: 0.13,1.00) for each axial elongation by 1 mm, and by 0.40 mmHg (95% CI: 0.06,0.74) for each increase in the degree of pseudoexfoliation, and it decreased by 0.40 mmHg (95% CI: 0.06,0.74) by cataract surgery.ConclusionsIn this study population aged 85+years, IOP readings showed similar relationships as in younger study populations, including positive associations with higher estimated CSFP and longer axial length and a negative association with cataract surgery.

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

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