Is Radical Prostatectomy a Useful Therapeutic Option for High-Risk Prostate Cancer in Older Men?

Abstract

Prostate cancer affects a high proportion of men over 70 years of age, who are likely to have high-risk disease and a substantial risk of prostate-cancer-specific death. With life expectancy increasing worldwide, the burden of prostate cancer is also expected to rise. Thus, effective management of this high-risk senior patient group is increasingly important. Radical prostatectomy can increase survival and decrease the risk of metastatic progression. Postsurgery complications are affected more by comorbidity than by age. In patients without comorbidities, surgery is associated with a low risk of mortality. Advanced age may increase the likelihood of incontinence following radical prostatectomy, but patients with higher risk disease are no more likely to experience this complication compared with lower risk groups. Treatment decisions should be made after considering the health status and life expectancy of the individual patient. If eligible, the patient should be offered radical prostatectomy as a potentially curative treatment, without a rigid restriction to a certain chronological age. The Oncologist 2012;17(suppl 1):4 -8

The Siconolfi step test: a valid and reliable assessment of cardiopulmonary fitness in older men with prostate cancer

“…It is well recognised that surgery can have a significant impact on catabolism and oxygen demand, and the length and extent of surgery is directly related to the risk of developing post-surgery complications [7]. Eligibility for radical prostatectomy is often based on chronological age, but evidence shows that post-surgery complications are affected more by comorbidities than age [8]. In clinical trials, even if there is no age limit, people are required to be “fit for treatment” as drug tolerance may decrease and toxicity may increase in those with poor fitness [9].…”

The Dilemma of Misclassification Rates in Senior Patients With Prostate Cancer, Who Were Treated With Robot-Assisted Radical Prostatectomy: Implications for Patient Counseling and Diagnostics

“…This phenomenon of misclassification likely explains findings of previous studies that reported rather higher rates of biochemical recurrence or even metastatic progression in senior men (5)(6)(7), since the studies adjusted for clinical parameters. In fact, such contradicting findings in combination with a rather dated concept to derive life expectancy based on demographics instead at the individual level supported the widely adopted notion to refrain from offering surgical local treatment to senior patients with PCa since the beneficiary potential of RARP appeared compromised (3,(8)(9)(10)(11). Alternatively, these patients will be offered radiotherapy or administration of an androgen deprivation therapy (12), both options potentially associated with high morbidity and comparably ineffective treatment of possible Pre-existing urinary tract symptoms (13).…”

Physician role in physical activity for African-American males undergoing radical prostatectomy for prostate cancer

“…African-American men are nearly 1.6 times more likely to be diagnosed with prostate cancer than white men and almost 2.5 times more likely to die from the disease [ 2 ], exhibiting the highest rates of prostate cancer incidence and mortality in the USA [ 1 , 2 ]. Radical prostatectomy (RP) provides effective control for prostate cancer resulting in high survival rates subsequently increasing the number of survivors across races [ 4 ]. Long-term complications like urinary incontinence and sexual dysfunction are a burden for many men after surgery, and African-American men have reported higher rates of urinary, bowel, and physical issues than Caucasian men [ 3 , 5 , 6 ].…”