Outcomes after surgery in men of 70 and older

The appropriateness of radical prostatectomy as a form of treatment of prostate cancer in men of 70 years of age and older has been questionned for all sorts of reasons over the years.

Froehner et al. have reviewed their data on  329 consecutive patients of ≥ 70 years of age who underwent radical prostatectomy between 1992 and 2004. The patients were stratified by five comorbidity classifications, by tumor stage, by Gleason score, and by PSA value. Mortality was subdivided into five categories as follows: overall, comorbid, competing, prostate cancer-specific, and second cancer-specific.

The results of this study have shown that:

  • The Charlson score was the best of the tested comorbidity classifications in men selected for radical prostatectomy at age 70 years or older.
  • In addition to a Gleason score of 8-10 (hazard ratio 2.61) and lymph node involvement (hazard ratio 2.89), a Charlson score of ≥ 1 was identified as an independent predictor of overall mortality (hazard ratio 2.16).
  • Elderly men with no comorbidities or adverse tumor-related risk factors had an excellent probability of 10-year overall survival (77-100 percent, depending on the classification used).
  • For patients with evident lymph node metastases or with Gleason score 8-10 disease, the probabilities of 10-year overall survival were only 30 and  33 percent, respectively.

The authors conclude that the Charlson comorbidity score may be used to stratify men selected for radical prostatectomy at age 70 years or older and to estimate the potential probability of 10-year survival.

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