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Radical prostatectomy in older men: survival outcomes in septuagenarians and octogenarians
Author(s) -
Pierorazio Phillip M.,
Humphreys Elizabeth,
Walsh Patrick C.,
Partin Alan W.,
Han Misop
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.2010.09239.x
Subject(s) - medicine , prostate cancer , prostatectomy , cause of death , cancer , survival rate , stage (stratigraphy) , prostate specific antigen , survival analysis , surgery , disease , urology , paleontology , biology
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To examine the survival outcomes of septuagenarians and octogenarians (aged ≥80 years) who underwent radical prostatectomy (RP) at our institution, as the US Preventive Services Task Force recently released recommendations that men aged ≥75 years should not be screened for prostate cancer. PATIENTS AND METHODS Our institutional RP database (1982–2008) was queried for men aged ≥70 years at the time of surgery to evaluate actuarial survival after RP; 386 aged 70–81 years (median 71) underwent RP. The median (range) follow‐up was 6.5 (1–22) years. Clinicopathological characteristics and mortality data were evaluated; mortality data were gathered through Social Security Administration Death Index and causes of death were confirmed with the Center for Disease Control National Death Index information. Kaplan‐Meier analysis was used to evaluate cause‐specific survival. RESULTS Ten patients (2.6%) had clinical stage T1a‐b, 213 (55.3%) had T1c, and 143 (37.1%) had T2 prostate cancer. The median (range) preoperative prostate‐specific antigen (PSA) level was 6.2 (0.2–49.9) ng/mL, and the biopsy and pathological Gleason sum was 6 (3–9) and 7 (4–9), respectively. Causes of death included prostate cancer (17), other malignancies (14), cardiovascular causes (14), neurological disease (four), pneumonia (two) and accident (one). The prostate cancer‐specific survival rate was 97.6%, 94.0% and 90.2% at 5, 10 and 15 years after RP, respectively; the respective cardiovascular survival rate was 99.5%, 97.6% and 92.5%, and the overall survival rate was 93.1%, 82.5% and 68.9%, respectively. CONCLUSIONS If appropriately selected, older men have excellent overall and prostate‐cancer specific survival after RP. The benefits of surgery should be weighed against the increased risks of surgical and anaesthetic complications.