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• W2084721423 abstract "No AccessJournal of UrologyAdult Urology1 May 2012Radical Prostatectomy Outcome in Men 65 Years Old or Older With Low Risk Prostate Cancer Jeffrey K. Mullins, Misop Han, Phillip M. Pierorazio, Alan W. Partin, and H. Ballentine Carter Jeffrey K. MullinsJeffrey K. Mullins More articles by this author , Misop HanMisop Han More articles by this author , Phillip M. PierorazioPhillip M. Pierorazio More articles by this author , Alan W. PartinAlan W. Partin More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.12.072AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A recent update of the Scandinavian Prostate Cancer Group Study-4 concluded that men older than 65 years treated with radical prostatectomy had no survival advantage compared to men treated with watchful waiting. We examined the proportion and outcomes of men 65 years old or older with low risk disease who underwent radical prostatectomy at our institution. Materials and Methods: Our institutional radical prostatectomy database with more than 19,000 patients was queried for men 65 years old or older with low risk prostate cancer. Pathological and survival outcomes were assessed. Subanalysis was done on men 70 years old or older to determine whether outcomes among older men differed by age. Results: A total of 1,560 men (8.1%) 65 years old or older with low risk prostate cancer underwent radical prostatectomy between 1983 and 2010. After radical prostatectomy 38.3% of the men had evidence of more aggressive cancer, including Gleason score 7 or greater, or extraprostatic extension. After radical prostatectomy actuarial 5, 10 and 15-year biochemical recurrence-free survival was 93.2%, 89.2% and 82.2%, prostate cancer specific survival was 99.7%, 98.4% and 97.2%, and overall survival was 96.1%, 83.5% and 60.2%, respectively. Conclusions: Fewer than 10% of men treated with radical prostatectomy at our institution were 65 years old or older with low risk prostate cancer. Despite a high prevalence of aggressive disease discovered at surgery these men experienced excellent long-term survival. Treatment recommendations in older men with low risk prostate cancer should be made after careful consideration of life expectancy based on comorbidities and potential adverse outcomes of treatment. References 1 : Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med2011; 364: 1708. Google Scholar 2 : Incidence of initial local therapy among men with lower-risk prostate cancer in the United States. J Natl Cancer Inst2006; 98: 1134. Google Scholar 3 : Outcomes after radical prostatectomy among men who are candidates for active surveillance: results from the SEARCH database. Urology2010; 76: 695. Google Scholar 4 : Pathological outcomes of candidates for active surveillance of prostate cancer. J Urol2009; 181: 1628. Link, Google Scholar 5 : Pathological findings and prostate specific antigen outcomes after radical prostatectomy in men eligible for active surveillance—does the risk of misclassification vary according to biopsy criteria?. J Urol2010; 183: 539. Link, Google Scholar 6 : Currently used criteria for active surveillance in men with low-risk prostate cancer: an analysis of pathologic features. Cancer2008; 113: 2068. Google Scholar 7 : Age-adjusted validation of the most stringent criteria for active surveillance in low-risk prostate cancer patients. Cancer2011; 118: 973. Google Scholar 8 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar 9 : Radical prostatectomy in older men: survival outcomes in septuagenarians and octogenarians. BJU Int2010; 106: 791. Google Scholar 10 : Survival analysis in men undergoing radical prostatectomy at an age of 70 years or older. Urol Oncol2010; 28: 628. Google Scholar 11 Wilt T: The VA/NCI/AHRQ CSP#407: Prostate Cancer Intervention Versus Observation Trial (PIVOT): main results from a randomized trial comparing radical prostatectomy to watchful waiting in men with clinically localized prostate cancer. Presented at annual meeting of American Urological Association, Washington, D.C., May 14–19, 2011. Google Scholar 12 : Expectant management of nonpalpable prostate cancer with curative intent: preliminary results. J Urol2002; 167: 1231. Link, Google Scholar 13 : Competing risk analysis after radical prostatectomy for clinically nonmetastatic prostate adenocarcinoma according to clinical Gleason score and patient age. J Urol2002; 168: 525. Link, Google Scholar 14 : Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology2006; 68: 1268. Google Scholar 15 : Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med2008; 358: 1250. Google Scholar 16 : Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA2010; 304: 2373. Google Scholar 17 : Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol2011; 29: 2185. Google Scholar 18 : The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. J Clin Oncol2004; 22: 2141. Google Scholar 19 : Trends in the treatment of localized prostate cancer using supplemented cancer registry data. BJU Int2011; 107: 576. Google Scholar The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGriebling T (2018) Re: Prostate Cancer Patients Older than 70 Years Treated by Radical Prostatectomy Have Higher Biochemical Recurrence Rate than their Matched Younger CounterpartJournal of Urology, VOL. 192, NO. 3, (768-769), Online publication date: 1-Sep-2014.Tosoian J, JohnBull E, Trock B, Landis P, Epstein J, Partin A, Walsh P and Carter H (2018) Pathological Outcomes in Men with Low Risk and Very Low Risk Prostate Cancer: Implications on the Practice of Active SurveillanceJournal of Urology, VOL. 190, NO. 4, (1218-1223), Online publication date: 1-Oct-2013. Volume 187Issue 5May 2012Page: 1620-1625 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsoutcome assessment (health care)prostateagedprostatectomyprostatic neoplasmsMetricsAuthor Information Jeffrey K. Mullins More articles by this author Misop Han More articles by this author Phillip M. Pierorazio More articles by this author Alan W. Partin More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2084721423 title "Radical Prostatectomy Outcome in Men 65 Years Old or Older With Low Risk Prostate Cancer" @default.
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