Men older than 80 years can undergo successful prostatectomy

Radical prostatectomy can be a reasonable option for select octogenarian patients, according to researchers from the Mayo Clinic, Rochester, MN. The findings, which run counter to the conventional practice of generally avoiding surgeries for individuals over 80 years old solely on the basis of age, were published recently in Urology (2006; 68:1042-5).

“Increased life expectancy and generally higher levels of wellness, as well as safer forms of anesthesia and less-invasive surgical techniques, have made it possible for older adults to safely and effectively have surgeries traditionally not offered over a certain age,” said Michael Lieber, MD, the study’s senior investigator. “We didn’t think that using age as the deciding factor was a valid argument for not performing a radical prostatectomy, and we proved that it is a safe option for some men.”

In the study, the team reviewed records for the 19 patients age 80 or older who underwent radical prostatectomy at the Mayo Clinic between 1986 and 2003. At the time of surgery, the average patient age was 81, the average PSA level was 10.2 ng/mL, and the average American Society of Anesthesiologists score was 2.4 out of five. Thirteen men had pathologic stage pT3 disease or a Gleason score of seven or more.

The researchers say the decision to perform a radical prostatectomy for each man was reasonable. Of the 19 patients, 14 remained continent, none died within a year of surgery or from prostate cancer, and the 10-year survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing a radical prostatectomy. Only three of the 19 men died from any cause within 10 years of the surgery.

“Decisions should be made on a case-by-case basis, but we feel surgery can be offered to very healthy, active octogenarians with localized prostate cancer with satisfactory results,” Dr. Lieber said.