To assess trends and factors driving aggressive surgery for patients >75 years diagnosed with prostate cancer (CaP), bladder cancer (BCa), and renal cell carcinoma (RCC).
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We identified all patients >75 years diagnosed with CaP, BCa, and RCC from the SEER-Medicare registry during 1992-2009. We analyzed the comorbidity and trends in radical cystectomy (RC), nephrectomy and radical prostatectomy (RP) for these cohorts. Predictive factors for receiving aggressive surgery were assessed using logistic regression analysis.
We identified cohorts of 85,073 CaP, 44,801 BCa, and 10,737 RCC patients. Among the BCa patients, 5.75% underwent RC and 78.2% had a Charlson comorbidity score (CCS) of ≤1. The trend of RC didn't change significantly. There was a significant change in receipt of RP (P=0.01). 85.8% of CaP patients had a CCS ≤1 and 2.67% underwent RP. Approximately 65.2% of RCC patients had nephrectomy while 76.2% had CCS of ≤1. There was a decline in receipt of nephrectomies (p<.0001). Younger age, high stage or grade disease and lower comorbidity were associated with higher odds of receiving RC, RP and nephrectomy.
In addition to stage and grade, age remains an important factor influencing the decision to undergo curative surgical therapy for PCa, BCa, and RCC patients >75 years. Comorbidity is also predictive, but to a lesser extent.
Urology. 2016 Jul 07 [Epub ahead of print]
Oluwakayode Adejoro, Amin Alishahi, Badrinath Konety
Department of Urology, University of Minnesota, Minneapolis, Minnesota., Department of Urology, University of Minnesota, Minneapolis, Minnesota., Department of Urology, University of Minnesota, Minneapolis, Minnesota. Electronic address: .