Tumour characteristics, oncological and functional outcomes in patients aged ≥ 70 years undergoing radical prostatectomy

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The marked increase in life expectancy in recent years calls for reconsideration of the decision‐making process for the treatment of prostate cancer, a condition particularly affecting the elderly. To date the general approach in elderly patients has tended to be more conservative, not least as it is generally thought that prostate cancer in these patients is less biologically aggressive. The present data showed that patients aged ≥70 years had biologically more aggressive tumours significantly more often than those aged <70 years. Nevertheless, advanced age itself was not an independent predictor of survival after retropubic radical prostatectomy, whereas adverse prostate cancer features and severe comorbidities were. OBJECTIVE To investigate the effect of advanced age (≥70 years) on prostate cancer characteristics, oncological and functional outcomes in patients undergoing retropubic radical prostatectomy (RP). PATIENTS AND METHODS Between June 1997 and September 2009, 1636 patients underwent RP at one institution. Of these patients, 1225 were aged < 70 years and 411 ≥70 years. Both groups were compared for prostate cancer characteristics, oncological and functional outcomes. Multivariate analyses were used to estimate the effect of advanced age on overall survival (OS), cancer‐specific survival (CSS), biochemical recurrence‐free survival (BFS) and postoperative continence. RESULTS The median (range) age of the patients aged ≥ 70 years was 72 (70–85) years and for those aged < 70 years was 64 (40–69) years (P < 0.001), respectively. The patients aged ≥ 70 years were assigned higher American Society of Anesthesiologists (ASA) classes (P < 0.001) reflecting a higher rate of severe comorbidities in this group. In the patients aged ≥ 70 years there were significantly more clinically palpable and pathologically non‐organ‐confined tumours (P= 0.030 and P= 0.026, respectively), and higher biopsy and RP Gleason scores (P= 0.002 and P= 0.004, respectively). Accordingly, patients aged ≥ 70 years presented with a higher proportion of high‐risk prostate cancer, although the difference was not significant (P= 0.060). There were no differences between the groups for preoperative prostate‐specific antigen level (P= 0.898), rate of pelvic lymph node dissection (P= 0.231), pN+ (P= 0.526) and R+ status (P= 0.590). Kaplan–Meier curves showed a significantly lower 10‐year OS (67 vs 82%; P= 0.017) and a trend towards a lower 10‐year CSS (70 vs 83%; P= 0.057) in patients aged ≥ 70 years. However, on multivariate analysis advanced age was not an independent predictor of OS (P= 0.102) or CSS (P= 0.195), whereas pN+ status (both P < 0.001), RP Gleason scores 8–10 (both P < 0.001) and ASA classes 3–4 (P= 0.037 and P= 0.028, respectively) were. The 2‐year postoperative continence rates was comparable between the groups (International Continence Society [ICS] male incontinence symptom score 2.10 vs 2.01; P= 0.984). In mult...

Pathological and Oncological Outcomes of Elderly Men with Clinically Localized Prostate Cancer

“…In the PIVOT study, 47.0% of patients (median age, 67 years) who underwent RP died during a median follow-up of 10 years. In the present study, the 5-year OS rate was 95.8% with the median age of 72 years among those 70 years of age, which was much better than that reported in the previous studies (3,12). Life expectancy in Japanese men is longer than that for men in other countries (4), and men under healthy conditions and less comorbidities would have undergone RP in our study.…”

“…With a median follow-up of 50 months, the 5-year bFS was 80.9% in those ,70 years of age and was 77.4% among those Jpn J Clin Oncol 2013;43 (12) 1239 70 years of age (P ¼ 0.217). The 5-year CSS was 99.8% in those ,70 years of age and was 99.5% among those 70 years of age (P ¼ 0.692).…”

“…In the present study, RP was more likely to be performed in patients with higher PSA, bGS and clinical stage among those 70 years of age, which resulted in a lower proportion of low-risk disease and a higher proportion of high-risk disease in those 70 years of age when compared with those ,70 years of age. Kunz et al reported that those 70 years of age presented with a higher proportion of high-risk disease when compared with those younger than 70 years of age among their 1636 patients undergoing RP (12). This may be because less aggressive treatment modalities, such as active surveillance, brachytherapy or external beam radiotherapy, are preferred in elderly patients (13).…”

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

“…Previous studies were retrospective and had significant bias between the age groups preoperatively. Kunz et al (9) reported that patients aged 70 years had biologically more aggressive and locally advanced tumors significantly more often than those aged ,70 years but that patients aged 70 years had significantly more clinically palpable tumors, higher biopsy Gleason scores and a higher proportion of high-risk disease. Brassell et al (8) reported that an age of 70 years was a significant predictor of biochemical recurrence after RP in multivariate analysis, although they had a statistically significant higher clinical stage, biopsy grade and PSA velocity pre-operatively.…”

Thoughtful PSA Screening in the Elderly: Context is Everything

“…Elderly patients may be at even greater risk for aggressive prostate tumors compared to younger men [7,8]. Frequently missed in discussions of PSA screening is the potential reduction in prostate cancer morbidity, including the development of metastatic disease and the potential avoidance of androgen deprivation therapy (ADT).…”