Radical prostatectomy in older men: survival outcomes in septuagenarians and octogenarians
Version of Record online: 26 AUG 2010
© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL
Volume 106, Issue 6, pages 791–795, September 2010
How to Cite
Pierorazio, P. M., Humphreys, E., Walsh, P. C., Partin, A. W. and Han, M. (2010), Radical prostatectomy in older men: survival outcomes in septuagenarians and octogenarians. BJU International, 106: 791–795. doi: 10.1111/j.1464-410X.2010.09239.x
- Issue online: 26 AUG 2010
- Version of Record online: 26 AUG 2010
- Accepted for publication 27 November 2009
- prostate cancer;
- radical prostatectomy;
Study Type – Therapy (case series) Level of Evidence 4
To examine the survival outcomes of septuagenarians and octogenarians (aged ≥80 years) who underwent radical prostatectomy (RP) at our institution, as the US Preventive Services Task Force recently released recommendations that men aged ≥75 years should not be screened for prostate cancer.
PATIENTS AND METHODS
Our institutional RP database (1982–2008) was queried for men aged ≥70 years at the time of surgery to evaluate actuarial survival after RP; 386 aged 70–81 years (median 71) underwent RP. The median (range) follow-up was 6.5 (1–22) years. Clinicopathological characteristics and mortality data were evaluated; mortality data were gathered through Social Security Administration Death Index and causes of death were confirmed with the Center for Disease Control National Death Index information. Kaplan-Meier analysis was used to evaluate cause-specific survival.
Ten patients (2.6%) had clinical stage T1a-b, 213 (55.3%) had T1c, and 143 (37.1%) had T2 prostate cancer. The median (range) preoperative prostate-specific antigen (PSA) level was 6.2 (0.2–49.9) ng/mL, and the biopsy and pathological Gleason sum was 6 (3–9) and 7 (4–9), respectively. Causes of death included prostate cancer (17), other malignancies (14), cardiovascular causes (14), neurological disease (four), pneumonia (two) and accident (one). The prostate cancer-specific survival rate was 97.6%, 94.0% and 90.2% at 5, 10 and 15 years after RP, respectively; the respective cardiovascular survival rate was 99.5%, 97.6% and 92.5%, and the overall survival rate was 93.1%, 82.5% and 68.9%, respectively.
If appropriately selected, older men have excellent overall and prostate-cancer specific survival after RP. The benefits of surgery should be weighed against the increased risks of surgical and anaesthetic complications.