Are Pathological and Oncological Outcomes of Elderly Men Treated with Radical Prostatectomy Worse than Those of Younger Men? Matched-pair Analysis Between Patients Aged <70 and ≥70 Years

Abstract

Objective: To compare oncological outcomes of patients aged 70 years treated with radical prostatectomy with those of a clinically matched younger cohort. Methods: Data from 1268 patients undergoing radical prostatectomy between 2000 and 2009 were retrospectively reviewed. Patients were classified according to age (,70 or 70 years) at the time of prostatectomy. After matching pre-operative factors (i.e. prostate specific antigen, positive biopsy cores, Gleason score, clinical stage and D'Amico risk group), 333 patients were chosen from each group. Results: The percentage of pathological stage T3 in those of age ,70 and 70 years was 30.3 and 33.0%, respectively (P ¼ 0.51). The percentage of pathological Gleason score 6, 7 and 8 was not significantly different between the two age groups (P ¼ 0.08). The percentage of organ-confined disease in those of age ,70 and 70 years was 69.4 and 67.0%, respectively (P ¼ 0.56). With a median follow-up of 50 months, 5-year prostate specific antigen recurrence-free survival in those of age ,70 and 70 years was 83.4 and 80.1%, respectively (log rank, P ¼ 0.199). Five-year cancer-specific survival in those of age ,70 and 70 years was 100 and 99.4%, respectively (log rank, P ¼ 0.317). Five-year overall survival in those of age ,70 and 70 years was 98.4 and 96.4%, respectively (log rank, P ¼ 0.228). Conclusions: Pathological and oncological outcomes in elderly patients (age 70 years) treated with radical prostatectomy were not significantly different from those of younger patients (age ,70 years). This information will help refine the indications for definitive treatment for localized prostate cancer in elderly men.

Evaluation and Management of the Geriatric Urologic Oncology Patient

“…A clinically-matched retrospective cohort analysis comparing patients greater than 70 years of age to those less than 70 found no difference in pathologic or oncologic outcomes, and no difference in five-year OS. 27 RP demonstrated improved life expectancy and quality-adjusted life expectancy compared to watchful waiting in men up to 75 years of age in cases of a moderately-differentiated disease, and up to 80 years in poorly differentiated disease. 28 The most common side effects of RP are erectile dysfunction and urinary incontinence, and increased age is an independent predictor of both.…”

Prostate Cancer Screening in the Fit Chilean Elderly: a Head to Head Comparison of Total Serum PSA versus Age Adjusted PSA versus Primary Circulating Prostate Cells to Detect Prostate Cancer at Initial Biopsy

“…However they also state that the ratio of harm to benefit increases with age, and that the likelihood of over diagnosis is extremely high, particularly in those with low risk disease (Carter et al, 2013). The European Association of Urology and NCCN indicate that radical treatment is appropriate in men with a life expectancy of 10 years (Heidenrich et al, 2012, NCCN 2014, and thus screening may be appropriate, especially as pathological and oncological outcomes in men >70 years treated by radical prostatectomy are not significantly different than those of younger patients (Mitsuzuka et al, 2014) and advancing age increases cancer specific mortality (Gandagalia et al, 2014)..…”