Patients aged more than 70 had higher risk of locally advanced prostate cancers and biochemical recurrence in Korea

Abstract

Study Type - Prognosis (cohort series) Level of Evidence 2b. What's known on the subject? and What does the study add? This study reports that patients aged 70 years or older have a higher possibility of locally advanced cancer than younger patients. Instead of conservative management, radical eradication of clinically localized prostate cancer should be actively considered in well-selected healthy patients older than 70 years.

Objective: • To analyse the differences in the clinicopathological results between two groups of Korean patients aged younger or older than 70 years with clinically localized prostate cancer.

Methods: • A cohort of consecutive male patients who underwent radical prostatectomy was retrospectively analysed. In total, 995 patients (74.6%) were younger than 70 years, and 338 patients (25.4%) were 70 years or older. • Biochemical recurrence (BCR) -free survival was evaluated in the patients, who were followed up for more than 24 months. • The Kaplan-Meier method was used to calculate survival estimates for BCR-free survival. Multivariate Cox proportional hazard regression analysis was performed to predict non-organ-confined status and BCR.

Results: • Mean preoperative prostate-specific antigen (PSA) levels and biopsy or pathological Gleason scores showed no differences between the two age groups. • Older patients, aged more than 70 years, displayed significantly higher risk of locally advanced prostate cancer and BCR than younger patients. • Subgroup analysis showed that the risk of the presence of locally advanced disease was significantly increased in patients of 70 years or older when we compared the proportion of locally advanced disease only in patients with PSA <4 ng/mL. • Multivariate analysis showed that old age, high PSA and high Gleason score were significantly associated with non-organ confined status and BCR.

Conclusions: • Patients aged 70 years or older had a higher possibility of locally advanced cancer than younger patients. • Radical eradication of clinically localized prostate cancer should be actively considered in well-selected healthy patients older than 70 years.

Trial registration: ClinicalTrials.gov NCT01347476.