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Prostate cancer patients older than 70 years treated by radical prostatectomy have higher biochemical recurrence rate than their matched younger counterpart
Author(s) -
Ko Jennifer,
Falzarano Sara M.,
Walker Esteban,
Streator Smith Karen,
Stephenson Andrew J.,
Klein Eric A.,
MagiGalluzzi Cristina
Publication year - 2013
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.22635
Subject(s) - medicine , prostatectomy , prostate cancer , biochemical recurrence , stage (stratigraphy) , urology , odds ratio , prostate , biopsy , cancer , gastroenterology , surgery , paleontology , biology
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. Prostate 73: 897–903, 2013. © 2012 Wiley Periodicals, Inc.