Radical prostatectomy a good option for some older men with prostate cancer

April 30, 2008

NEW YORK (Reuters Health) - For men aged 70 years and older with prostate cancer but without major co-morbidities and who have a life expectancy of at least 10 years, radical retropubic prostatectomy (RRP) is "a real option," a New York investigator told Reuters Health.

In an interview, Dr. Lee Richstone of The North Shore-LIJ Health System in New York, discussed results of a study he led involving 258 men aged 70 years and older who underwent RRP.

Dr. Richstone's team compared clinical outcomes, pathology results and consequent upgrading of the Gleason biopsy score and upstaging of the tumor, and survival of the study group with that of 3,777 similar controls less than 70 years of age.

The older group had cancers of higher clinical stage and a lower frequency of organ-confined disease at the time of surgery than the younger men, at 58.1% and 69.9%, respectively.

There was an upgrading of Gleason score in 45.0% of older men compared with 35.2% of younger men. "However, age was not associated with upgrading on a multivariate analysis," Dr. Richstone and colleagues report in the March issue of BJU International. Upstaging was more frequent in older men than in younger men, at 40.2% and 29.3%, respectively.

There was no difference in cancer-specific survival, which was 96% at 10 years, or in biochemical disease progression-free probability at 10 years, at 74% in older and 75% in younger men.

"It is well known that many physicians fail to consider radical prostatectomy as a treatment option for prostate cancer in men over the age of 70 due to an age bias," Dr. Richstone commented to Reuters Health. "The truth is that men are living longer, and many septuagenarians are extremely fit, with few co-morbidities, and significant life expectancies in excess of 10 years."

"Until now, there were limited data on the accuracy of predictive tables to guide treatment decisions, and we have demonstrated their validity in this setting," Dr. Richstone said of his study.

"As with all treatment decisions regarding prostate cancer, the key issue is patient selection," he cautioned. "We do not advocate RRP in all men older than 70 with prostate cancer, but for healthy older men with significant life expectancy, we demonstrate that RRP is a real option."