BACKGROUND: Consensus on prostate cancer (PCA) treatment in older men is currently lacking.
We evaluated clinicopathological and oncological outcomes in patients >70-year-old treated with radical prostatectomy (RP).
METHODS: Clinicopathological and follow-up (FU) data for >70-year-old RP men (2000-2011) were recorded. Association between preoperative features, extraprostatic extension (EPE) and biochemical failure (bF), and postoperative features and bF, was explored. Patients >70-year-old were matched with younger (50- to 70-year-old) men with similar RP features to analyze the effect of age on bF.
RESULTS:Two hundred eighteen RP patients were >70-year-old. Clinical stage (cT) was T1 in 74.1%. Biopsy (Bx) Gleason score (GS) was 6 (35.8%), 7 (45.9%), and ≥8 (18.3%); RP GS was 6 (10.1%), 7 (63.3%), and ≥8 (26.6%). Median PSAD was 0.14 (range: 0.01-1.12). Pathologic stage (pT) was pT3 in 45.9%. bF occurred in 14.0%. Best preoperative predictive model for pT3 disease included D'Amico risk, number of Bx positive cores, PSAD, maximum % of PCA per core (P < 0.0001); cT, PSAD and primary Bx Gleason pattern best predicted bF preoperatively (P = 0.0031). Among postoperative features, high RP GS, positive margins, and pT3 were significantly associated with bF. Margin status and pT best predicted bF. Patients >70-year-old had 85% higher odds of bF compared to younger men (P = 0.036).
CONCLUSIONS: PCA detected in >70-year-old men shows adverse pathologic features. Failure rate is significantly higher in older than in matched younger patients.
Written by:
Ko J, Falzarano SM, Walker E, Streator Smith K, Stephenson AJ, Klein EA, Magi-Galluzzi C. Are you the author?
Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
Reference: Prostate. 2012 Dec 31. Epub ahead of print.
doi: 10.1002/pros.22635
PubMed Abstract
PMID: 23280623
UroToday.com Prostate Cancer Section
