Prostate cancer patients older than 70 years treated by radical prostatectomy have higher biochemical recurrence rate than their matched younger counterpart

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.