Are older prostate cancer patients (aged 75 years or more) candidates for surgery?

This study examined prostate surgery as a treatment option for older prostate cancer patients compared to younger patients. The authors concluded that prostate cancer patients aged 75 years or more can be suitable candidates for surgery.

Radical treatment options for prostate cancer, such as surgery, are often not recommended for older men. This is due to lower life expectancies and the increased likelihood of additional medical conditions. Older men may receive conservative therapies or no therapies at the risk of treatment-related side effects. However, overall life expectancies are expected to continue to increase. It has therefore been argued that men aged 75 or more may also benefit from the survival advantage that prostate surgery offers.

The aim of this study was to examine treatment outcomes with prostate surgery for men aged 75 or more.

The records of 13,997 men treated with prostate surgery were analyzed. 13,731 of these men were younger than 75 years. 265 men were aged 75 or older. Treatment outcomes were compared between older and younger men. The average follow-up after surgery was 47.3 months.

Overall, older men undergoing surgery were more likely to have advanced disease. Older men more commonly had aggressive cancer cells (based on tissue samples), tumor protruding into nearby tissue, and cancer spread to local lymph nodes. They were also more likely to receive additional hormone therapy after surgery.

5-year overall survival rate (proportion who have not died from any cause since treatment) was 91.3% for older men and 96.2% for younger men. 5-year cancer specific survival rate (proportion who have not died from prostate cancer since treatment) was 98.4% for older men and 99% for younger men. 64.2% of older men and 76.9% of younger men were recurrence-free at 5 years. 84.7% of older men and 96.2% of younger men showed no signs of cancer spread (metastasis) to distant parts of the body 5 years after surgery.

Disease recurrence (based on blood tests) was 2.13 times more likely for older patients. The risk of metastasis was also increased by 91% among older men. Age was associated with an increased mortality risk from all causes. However, older age did not significantly increase the risk of mortality from prostate cancer.

The authors concluded that healthy older prostate cancer patients can be suitable candidates for surgery. While older men had more advanced disease at surgery and were at increased risk of disease recurrence and progression, their risk of mortality was low.