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The relationship between age at time of surgery and risk of biochemical failure after radical prostatectomy
Author(s) -
Barlow LaMont J.,
Badalato Gina M.,
Bashir Talha,
Benson Mitchell C.,
McKiernan James M.
Publication year - 2010
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/j.1464-410x.2009.08977.x
Subject(s) - medicine , prostatectomy , prostate cancer , hazard ratio , proportional hazards model , stage (stratigraphy) , biochemical recurrence , prostate specific antigen , confidence interval , multivariate analysis , urology , univariate analysis , t stage , cancer , oncology , paleontology , biology
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVES To evaluate the effects of age at radical prostatectomy (RP) on recurrence‐free survival (RFS) in patients with prostate cancer stratified by established preoperative risk factors (such as prostate‐specific antigen (PSA) level, Gleason score, and tumour stage), as increasing age has been associated with more indolent behaviour in some cancers. PATIENTS AND METHODS A retrospective analysis of men treated with RP from 1988 to 2008 was conducted. Patients were divided into two groups by age at the time of RP, and RFS rates were analysed using Kaplan–Meier survival curves. The subgroups were stratified by preoperative PSA level, biopsy Gleason score, and clinical stage; multivariate analyses with Cox proportional hazards models were used to identify independent predictors of recurrence. Recurrence was defined as a single PSA level of ≥0.2 ng/mL at least 28 days after RP. RESULTS In all, 1984 patients met inclusion criteria and were divided into groups 1 (1325 men aged 40–64 years) and 2 (659 men aged ≥65 years). The 5‐year RFS rates were 80.6% (confidence interval, CI 78.0–82.9%) and 75.6% (CI 71.5–79.1%) for groups 1 and 2, respectively. In the univariate model, advanced age was significantly associated with an increased overall risk of recurrence (hazard ratio, HR 1.30, P = 0.012). However, in multivariate analyses accounting for PSA level, Gleason score, and clinical stage, age was not an independent predictor of recurrence (HR 1.04, P = 0.76). CONCLUSION Older patients who undergo RP appear to have an increased risk of recurrence. However, age is not an independent predictor of recurrence when accounting for PSA level, grade, and stage.