Advanced age portends poorer prognosis after radical prostatectomy: a single center experience.
Advanced age
Prostate cancer
Prostate cancer progression
Robot-assisted radical prostatectomy
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
received:
12
05
2022
accepted:
25
07
2022
pubmed:
18
8
2022
medline:
23
11
2022
entrez:
17
8
2022
Statut:
ppublish
Résumé
Although advanced age doesn't seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center. 1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases. 243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7-42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844-15.237; p = 0.002) compared to the younger patients. Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.
Identifiants
pubmed: 35976572
doi: 10.1007/s40520-022-02213-w
pii: 10.1007/s40520-022-02213-w
pmc: PMC9675672
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2857-2863Informations de copyright
© 2022. The Author(s).
Références
Mottet N, Cornford P, van den Bergh RCN, et al (2022) EAU - EANM - ESTRO - ESUR - ISUP - SIOG Guidelines on Prostate Cancer. In: Eur. Assoc. Urol. https://uroweb.org/guidelines/prostate-cancer . Accessed 2 May 2022
Schaeffer E, Srinivas S, Antonarakis ES, et al (2022) Prostate Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. In: Natl. Compr. Cancer Netw. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf . Accessed 2 May 2022
Greco KA, Meeks JJ, Wu S et al (2009) Robot-assisted radical prostatectomy in men aged ≥70 years. BJU Int 104:1492–1495. https://doi.org/10.1111/J.1464-410X.2009.08718.X
doi: 10.1111/J.1464-410X.2009.08718.X
pubmed: 19583731
Gurung PMS, Wang B, Hassig S et al (2021) Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis. World J Urol 39:1131–1140. https://doi.org/10.1007/S00345-020-03304-X
doi: 10.1007/S00345-020-03304-X
pubmed: 32537666
Leyh-Bannurah SR, Wagner C, Schuette A et al (2022) Feasibility of robot-assisted radical prostatectomy in men at senior age ≥75 years: perioperative, functional, and oncological outcomes of a high-volume center. Aging Male 25:8–16. https://doi.org/10.1080/13685538.2021.2018417
doi: 10.1080/13685538.2021.2018417
pubmed: 34957914
Traboulsi SL, Nguyen DD, Zakaria AS et al (2020) Functional and perioperative outcomes in elderly men after robotic-assisted radical prostatectomy for prostate cancer. World J Urol 38:2791–2798. https://doi.org/10.1007/S00345-020-03096-0
doi: 10.1007/S00345-020-03096-0
pubmed: 32034499
Nakamura LY, Nunez RN, Andrews PE et al (2011) Older age does not impact perioperative complications after robot-assisted radical prostatectomy. J Robot Surg 5:201–208. https://doi.org/10.1007/S11701-011-0251-1
doi: 10.1007/S11701-011-0251-1
pubmed: 27637708
Togashi K, Hatakeyama S, Okamoto T et al (2021) Oncologic and patient-reported outcomes after robot-assisted radical prostatectomy in men aged ≥75 years. Urol Oncol Semin Orig Investig 39:729.e17-729.e25. https://doi.org/10.1016/J.UROLONC.2020.12.001
doi: 10.1016/J.UROLONC.2020.12.001
Yamada Y, Teshima T, Fujimura T et al (2020) Comparison of perioperative outcomes in elderly (age ≧ 75 years) vs younger men undergoing robot-assisted radical prostatectomy. PLoS ONE 15:e0234113. https://doi.org/10.1371/JOURNAL.PONE.0234113
doi: 10.1371/JOURNAL.PONE.0234113
pubmed: 32497131
pmcid: 7272059
Bechis SK, Carroll PR, Cooperberg MR (2011) Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 29:235–241. https://doi.org/10.1200/JCO.2010.30.2075
doi: 10.1200/JCO.2010.30.2075
pubmed: 21135285
Dripps RD, Lamont A, Eckenhoff JE (1961) The role of anesthesia in surgical mortality. JAMA 178:261–266. https://doi.org/10.1001/JAMA.1961.03040420001001
doi: 10.1001/JAMA.1961.03040420001001
pubmed: 13887881
Sebben M, Tafuri A, Shakir A et al (2020) The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy. World J Urol 38:2799–2809. https://doi.org/10.1007/S00345-020-03094-2
doi: 10.1007/S00345-020-03094-2
pubmed: 31980875
van der Kwast TH, Amin MB, Billis A, et al (2010) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume. Mod Pathol 2011 241 24:16–25. https://doi.org/10.1038/modpathol.2010.156
Labanaris AP, Witt JH, Zugor V (2012) Robotic-assisted radical prostatectomy in men ≥75 years of age. surgical. Oncol Funct Outcomes Anticancer Res 32:2085–2089
Kumar A, Samavedi S, Bates AS et al (2015) Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy–A propensity score matched study. Eur J Surg Oncol 41:837–843. https://doi.org/10.1016/J.EJSO.2015.04.006
doi: 10.1016/J.EJSO.2015.04.006
pubmed: 25980748
Ubrig B, Boy A, Heiland M et al (2018) Outcome of robotic radical prostatectomy in men over 74. J Endourol 32:106–110. https://doi.org/10.1089/END.2017.0512
doi: 10.1089/END.2017.0512
pubmed: 29232985
pmcid: 5813731
Mandel P, Kriegmair MC, Kamphake J et al (2016) Tumor characteristics and oncologic outcome after radical prostatectomy in men 75 years old or older. J Urol 196:89–94. https://doi.org/10.1016/J.JURO.2016.01.009
doi: 10.1016/J.JURO.2016.01.009
pubmed: 26796415
Imnadze M, Sjoberg DD, Vickers AJ (2016) Adverse pathologic features at radical prostatectomy: effect of preoperative risk on oncologic outcomes. Eur Urol 69:143–148. https://doi.org/10.1016/J.EURURO.2015.03.044
doi: 10.1016/J.EURURO.2015.03.044
pubmed: 25913389