Prostate Cancer in Patients over Age 70 Treated by Radical Prostatectomy: Clinicopathologic Features and Outcome
Jennifer Ko, Sara M Falzarano, Esteban Walker, Karen Streator Smith, Eric A Klein, Ming Zhou, Cristina Magi-Galluzzi. Cleveland Clinic, Cleveland
Background: Prostate cancer (PCA) is an increasingly important and controversial health care issue in aging populations. Consensus on screening recommendations in older men is lacking. We evaluated clinicopathologic features and outcome of patients (pts) >70 years who underwent radical prostatectomy (RP).
Design: Clinicopathologic features and follow-up (FU) data of RP pts diagnosed with PCA (2000-2011) were recorded. Pts given neoadjuvant therapy were excluded. Biochemical recurrence (PSAR) was defined as PSA >0.3 ng/ml after RP. Association between preoperative features (age, PSA, clinical stage [cT], biopsy [Bx] 1º and 2º Gleason pattern, Bx Gleason score [GS], highest percentage of core involvement [%hci]) and incidence of extraprostatic extension (EPE) was evaluated in univariate and multivariate analyses. Associations between postoperative features (RP GS, EPE, seminal vesicle involvement [SVI], margin of resection [MOR], pathologic stage [pT], tumor volume [TV]) and PSAR were evaluated in univariate analysis.
Results: 184 pts were >70 years old. Median age and preoperative PSA was 72 years and 6.00 ng/ml. Bx GS, cT (available in 183 pts), risk stratification by D'Amico criteria, RP GS, EPE, SVI, MOR, pT, and TV are displayed in Table 1. %hci was >50% in 70 (40%) and ≤50% in 106 (60%). Median FU was12.5 months (range 1-130). PSAR occurred in 14 (9%) pts. In univariate analysis, cT, Bx 1º Gleason pattern, Bx GS, %hci >50, and D'Amico groups were significantly associated with EPE (p<0.05). In multivariate analysis Bx GS and %hci >50 retained significance. Univariately, RP GS, EPE, MOR status, and pT were significantly associated with presence of PSAR (p<0.05).
Conclusions: PCA in elderly population shows parameters of aggressive disease, such as RP GS ≥7 in >90%, EPE in 39%, pT3 in 47%, and positive MOR in 36% of pts. Although these parameters are significantly associated with PSAR, the overall recurrence rate in our study was lower than previously reported. Longer FU is necessary to better estimate the impact of PCA biology on outcome.
|Clinical stage (cT)||# Patients (%)|
|D'Amico risk criteria|
|Pathologic stage (pT)|
|Low (<0.5 cc)||22 (12%)|
|Medium (0.5-2.0 cc)||93 (50%)|
|Extensive (>2.0 cc)||69 (37%)|