Radical prostatectomy in men aged ≥70 years: effect of age on upgrading, upstaging, and the accuracy of a preoperative nomogram

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OBJECTIVESTo determine the effect of age on clinicopathological features, the accuracy of the preoperative nomogram, and survival after radical retropubic prostatectomy (RRP), as there are limited data on elderly men undergoing RRP.PATIENTS AND METHODSA database of 258 men aged ≥70 years and 3777 aged <70 years who had RRP was reviewed to compare the clinicopathological features and survival between the age groups. The effect of age on the frequency of upgrading from biopsy Gleason sum 2–6 to pathology Gleason sum ≥7, and upstaging from clinical T1–T2 to pathological stage T3–T4 was also evaluated.RESULTSMen aged ≥70 years had cancers of higher clinical stage (P = 0.001), pathology Gleason sums (P = 0.01) and a lower frequency of organ-confined disease than men aged <70 years (58.1% and 69.9%, respectively, P = 0.001). There was upgrading in 76/169 (45.0%) men aged ≥70 years and in 936/2656 (35.2%) of men aged <70 years (P = 0.01). However, age was not associated with upgrading on a multivariate analysis. Upstaging was more frequent in older than in younger men (40.2% and 29.3%, respectively, P = 0.001). Age ≥70 years was associated with upstaging on multivariate logistic regression but did not affect the accuracy of the Partin tables (P = 0.14) or Kattan nomograms (P = 0.53). There was no difference in cancer-specific survival (96% at 10 years, P = 0.33) or biochemical progression-free probability between the age groups (74% and 75% at 10 years, respectively, P = 0.13).CONCLUSIONSPatients aged ≥70 years are more likely to be upstaged after RRP, but this does not affect cancer control. In addition, nomograms maintain their accuracy and remain valid tools in this rapidly growing patient population.

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