Radical prostatectomy may be a safe option for the treatment of prostate cancer in otherwise healthy men up to age 79, according to a new study in the October 19 issue of the Journal of the National Cancer Institute.
Prostate cancer is the most common non-skin cancer in American men and the third most common cause of cancer death. In patients with localized disease, radical prostatectomy is associated with lower disease-specific mortality, lower rates of local progression and metastases, and higher overall survival compared with conservative management. However, few men older than age 70 are treated with radical prostatectomy. A recent survey found that 69% of Canadian urologists and 53% of American urologists believed that age 70 should be the upper age limit for the procedure.
To determine whether the low use of radical prostatectomy in men ages 70 and older is justified by the complication and/or mortality rates, Shabbir M. H. Alibhai, M.D., of the University Health Network and the Toronto Rehabilitation Institute, and colleagues examined mortality and complications within 30 days following radical prostatectomy in 11,010 men who underwent this surgery in Ontario between 1990 and 1999.
Overall, 53 men (0.5%) died, and 2,246 (20.4%) experienced one or more complications within 30 days of surgery. Age was associated with an increased risk of 30-day mortality, but the absolute risk of death was low even among men ages 70 to 79; 0.66% of men in this age group died within 30 days of surgery. The presence of comorbid conditions, particularly cardiovascular disease or stroke, was a stronger predictor than age of nearly all categories of complications.
"We conclude that radical prostatectomy was fairly safe for otherwise healthy older men up to at least age 79 years," the authors write. "Further research should examine the utility of detailed preoperative assessment of older men considering radical prostatectomy and interventions designed to reduce the risk of major complications in older men undergoing radical prostatectomy."