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Higher rates of upgrading and upstaging in older patients undergoing radical prostatectomy and qualifying for active surveillance
Author(s) -
Busch Jonas,
Magheli Ahmed,
Leva Natalia,
Ferrari Michelle,
Kramer Juergen,
Klopf Christian,
Kempkensteffen Carsten,
Miller Kurt,
Brooks James D.,
Gonzalgo Mark L.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12466
Subject(s) - medicine , prostatectomy , prostate cancer , logistic regression , pathological , watchful waiting , proportional hazards model , nomogram , propensity score matching , urology , prostate specific antigen , oncology , gynecology , cancer
Objective To determine pathological and oncological outcomes of patients diagnosed with low‐risk prostate cancer in two age cohorts who underwent radical prostatectomy ( RP ) and qualified for active surveillance ( AS ) according to Prostate Cancer Research International: Active Surveillance ( PRIAS ) criteria, as AS for low‐risk prostate cancer represents an acceptable management strategy especially for older patients.Patients and Methods In all, 320 patients aged ≥65 years who underwent RP and were eligible for AS according to PRIAS criteria were propensity score matched 1:1 to patients aged <65 years. Patient characteristics were compared with chi‐square, K ruskal– W allis, and one‐way anova tests. Predictors of RP pathological upgrading or upstaging were analysed using logistic regression. Recurrence‐free survival ( RFS ) and overall survival ( OS ) were calculated using the K aplan– M eier method. Predictors of RFS were analysed within C ox regression models.Results Pathological upgrading and upstaging were significantly higher among older (≥65 years) vs younger (<65 years) patients (53.1% vs 44.1% and 12.2% vs 7.2%, respectively). Higher prostate‐specific antigen levels and increasing age were independent predictors of upgrading among patients aged <65 years. There were no differences in RFS or OS between the two age groups. Positive surgical margin status was the only independent predictor of shorter RFS .Conclusions Patients aged ≥65 years who are eligible for AS by PRIAS criteria have a higher risk of being upgraded and upstaged at RP than those aged <65 years. These findings should be taken into consideration when discussing treatment options for patients diagnosed with prostate cancer.