Tumor characteristics and oncological outcome after radical prostatectomy in men 75 years and older.

PUROSE - As life expectancy increases, oncological outcome in elderly patients ≥75 years is a salient topic requiring further investigation.

MATERIALS AND METHODS - A total of 13997 patients who underwent RP from 2006 to 2013 were analyzed.

Known prognosticators were compared according to patient age at RP (13732 patients<75 years versus 265 patients≥75 years). Uni- and multivariate Cox regressions were used to estimate the impact of age on biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) RESULTS: Median follow up was 47. 3 months. Patients ≥75 years compared to patients <75 years had a higher pathologic Gleason score (p<0. 001), were more likely to harbor non-organ-confined tumor (p<0. 001), to have positive surgical margin (p=0. 004) and positive lymph nodes (p=0. 028) and to receive salvage ADT (p=0. 002). 5-year BCR-free survival, MFS, CSS and overall survival were 64. 2%, 84. 7%, 98. 4% and 91. 3% for patients ≥75 years and 76. 9%, 96. 2%, 99. 0% and 96. 2% for patients <75 years. In uni- and multivariate analysis age ≥75 was associated with a worse BCR-free survival and MFS. Patients ≥75 years were more likely to die from other causes than cancer. Nevertheless non-cancer related mortality was very low.

CONCLUSIONS - Older patients who underwent RP had more advanced disease. Age itself is an independent predictor of worse BCR-free and MFS. Healthy and highly selected patients ≥75 years in our sample showed good long-term overall survival. Therefore, older age in well selected men should not be a contraindication for RP, especially in patients harboring high-risk disease.

The Journal of urology. 2016 Jan 18 [Epub ahead of print]

Philipp Mandel, Maximilian C Kriegmair, Janneke Kleine Kamphake, Felix K-H Chun, Markus Graefen, Hartwig Huland, Derya Tilki

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , Department of Urology, University Medical Centre Mannheim, Mannheim, Germany. , Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.  

PubMed