UroToday - In the online issue of the World Journal of Urology, a group headed by Professor Markus Hohenfellner compared the outcomes of radical prostatectomy (RP) in men younger and older than age 70 years. They suggest that in well-selected men over age 70 years, the outcomes are comparable.

The study cohort consisted of 626 men who underwent RP at their institution between 1990 and 2006. A total of 526 were younger than 70 years old, and 100 were older than 70 years. The majority underwent radical retropubic RP and 46 underwent a perineal approach. The majority had a pelvic lymphadenectomy performed. Median patient age was 64.4 years, median PSA was 8.9ng/ml, and median follow-up was 5.3 years. For the analysis pre-op PSA, pathologic tumor stage, WHO tumor grading, margin status, time of PSA recurrence, time of distant metastatic recurrence, CaP specific and overall survival were considered.

ECOG status was >1 in 7% of the older cohort compared to 2.3% of the younger men. While median age was almost 10 years older, percentage of organ-confined cancer, grade, positive lymph node and positive margin status did not differ. Median PSA-free survival was 10.2 years for the young men and not yet reached for the older men. The 10-year PSA-free survival was 51.8% for the young and 57.4% for the older men. The 10-year metastasis-free survival was 86.9% and 89.7% for the 70 year old patients, respectively. The 10-year prostate cancer specific survival was 92.3% and 97.6% for the young and old men, respectively. Median overall survival was 14 and 12.4 years and 10-year overall survival was 78.1% and 71.2% for the 70 year old patients, respectively. In multivariable analysis, there was no difference in any of the categories for clinical outcome where the age was a risk factor for adverse outcome.

Pfitzenmaier J, Pahernik S, Buse S, Haferkamp A, Djakovic N, Hohenfellner M
World J Urol. 2009 Apr 26. Epub ahead of print.

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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