Radical prostatectomy outcome in men 65 years old or older with low risk prostate cancer

A recent update of the Scandinavian Prostate Cancer Group Study-4 concluded that men older than 65 years treated with radical prostatectomy had no survival advantage compared to men treated with watchful waiting. We examined the proportion and outcomes of men 65 years old or older with low risk disease who underwent radical prostatectomy at our institution.

Our institutional radical prostatectomy database with more than 19,000 patients was queried for men 65 years old or older with low risk prostate cancer. Pathological and survival outcomes were assessed. Subanalysis was done on men 70 years old or older to determine whether outcomes among older men differed by age.

A total of 1,560 men (8.1%) 65 years old or older with low risk prostate cancer underwent radical prostatectomy between 1983 and 2010. After radical prostatectomy 38.3% of the men had evidence of more aggressive cancer, including Gleason score 7 or greater, or extraprostatic extension. After radical prostatectomy actuarial 5, 10 and 15-year biochemical recurrence-free survival was 93.2%, 89.2% and 82.2%, prostate cancer specific survival was 99.7%, 98.4% and 97.2%, and overall survival was 96.1%, 83.5% and 60.2%, respectively.

Fewer than 10% of men treated with radical prostatectomy at our institution were 65 years old or older with low risk prostate cancer. Despite a high prevalence of aggressive disease discovered at surgery these men experienced excellent long-term survival. Treatment recommendations in older men with low risk prostate cancer should be made after careful consideration of life expectancy based on comorbidities and potential adverse outcomes of treatment.