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Radical Prostatectomy Outcomes in Men Aged 70 or older with Low-Risk Prostate Cancer
Jeffrey K Mullins, Misop Han, Alan W Partin, Patrick C Walsh, H Ballentine Carter
Johns Hopkins Medical Institutions, Baltimore, MD

A recent study of SEER data considered men aged > 70 years with moderately differentiated prostate cancer (PCa) as having lower-risk disease(Miller et al, JNCI 2006). This study also concluded that a significant portion of these men were overtreated with radical prostatectomy (RP) or radiation therapy. We examined the proportion and outcomes of men aged > 70 years who underwent RP with low-risk disease at our institution over the past three decades.
Materials and Methods:
Our institutional RP database with more than 19,000 men was queried for elderly men aged ≥70 years with low risk PCa (PSA<10 ng/ml, biopsy Gleason < 6, and clinical stage T1c/T2a). Pathologic and survival outcomes were assessed.
Between 1983 and 2010, 169 elderly men with low risk PCa (0.88%) underwent RP. Gleason score at RP was > 7 in 55 (32.5%). Pathologic stage was pT2 in 119 (70.4%), pT3a in 43 (25.4%), pT3b in 6 (3.6%), and N1 in 1 (0.6%). Actuarial 5- /10-yr biochemical recurrence-free survival, PCa-specific survival, and overall survival probability following RP were 88%/ 77%, 98% /87%, and 87%/63%, respectively.

Less than 1% of men undergoing RP at our institution were elderly men with low risk PCa. However, many of these men were found to have higher risk disease after RP. These cancers may be life-threatening in men with few comorbidities. Treatment recommendation in elderly men with low risk PCa should made after careful consideration of life expectancy based on comorbidities and potential adverse outcomes from the treatment.

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