Post-radical prostatectomy outcomes not influenced by advanced age

Essen, Germany-Advanced age does not influence postoperative continence or cancer-specific survival after radical prostatectomy, according to a study comparing these outcomes in men 70 years of age and older and those younger than 70 years.

Therefore, general exclusion of older patients from RP “would represent a missed opportunity to avoid disease-related deaths and the consequences of local cancer progression,” said lead investigator Inga Kunz, MD, urology resident at Kliniken-Essen-Mitte, in Essen, Germany, who worked on the study with Darko Kroepfl, MD, and colleagues.

Treatment for prostate cancer in older patients tends to be conservative due to a presumed short life expectancy, but in Germany, men 70 to 80 years of age still have an average life expectancy of 13 and 8 years, respectively, said Dr. Kunz, who presented the findings at the 2012 AUA annual meeting in Atlanta. Data were subsequently published online in BJU International (Sept. 5, 2012).

Recent studies indicate that older men often develop more aggressive and poorly differentiated tumors, with higher rates of biochemical recurrence and secondary treatment.

Dr. Kunz and colleagues sought to characterize prostate cancer in older versus younger men at her institution, and examined outcome after prostatectomy according to age.

The study population consisted of 1,636 patients who underwent radical prostatectomy between 1997 and 2009. Some 411 of the men were 70 years of age or older; 1,225 were younger than 70 years.

Both age groups were compared for prostate cancer characteristics, postoperative continence, overall survival, cancer-specific survival, and biochemical recurrence-free survival. Multivariate analyses were conducted to adjust for the influence of age.

The median ages of patients 70 years of age and older and those younger than 70 years were 72 and 64 years, respectively. There were no differences between the two groups with respect to preoperative PSA level (8.0 ng/mL in those 70 years of age and older vs. 8.2 ng/mL in those younger than 70 years), prostate weight, positive surgical margin (33.55% vs. 32.10% R1), and lymph node status.

Patients 70 years of age and older were more often assigned to American Society of Anesthesiologists (ASA)-class 3 (19.5% vs. 11.3%; p<.0001), more likely to have biopsy Gleason scores 8 to 10 (13.4% vs. 8.3%; p=.002), more likely to have prostatectomy Gleason scores 7 (37.8% vs. 31.8%) and 8 to 10 (16.4% vs. 12.8%; p=.0013), and more often had pT3/4 tumors (55.2% vs. 47.7%; p=.0096).

Kaplan-Meier curves demonstrated a significantly lower 10-year overall survival (67% vs. 82%; p=.01), a nonsignificant trend toward a lower 10-year cancer-specific survival (70% vs. 83%; p=.06), and a statistically comparable rate of biochemical recurrence-free survival (38% vs. 45%; p=.57) in patients 70 years of age and older versus those younger than 70 years.

Age not predictor on multivariate analysis

On multivariate analysis, however, advanced age was not an independent predictor of overall survival (hazard ratio [HR]=1.446; p=.110) and cancer-specific survival (HR=1.386; p=.1949), whereas positive node status (p<.0001), prostatectomy Gleason scores 8 to 10 (p=.0009 and p<.0001, respectively), and ASA class 3 (p=.0369 and p=.0279, respectively) were independent predictors.

“In univariate analysis on the outcome of continence, both age groups had comparably good results,” Dr. Kunz said. “In multivariate analysis, age again turned out not to be an independent predictor; here, only preoperative continence was an independent predictor.”

The 2-year postoperative International Continence Society male questionnaire short form (ICSmaleSF) incontinence symptom scores were 2.10 in the group 70 years of age and older versus 2.01 in the younger group (p=.9843). In multivariate analysis, the score depended only on the preoperative ICSmaleSF incontinence symptom score (p<.0001) but not on advanced age (p=.3410).

“Despite the higher biological aggressiveness [in older men], good long-term oncologic results and good postoperative continence were achieved,” Dr. Kunz said.UT