Is age associated with a poorer outcome for patients undergoing delayed prostate surgery following active surveillance?

This study looked at whether age is related to a risk of poor outcomes in men undergoing delayed radical prostatectomy (RP; prostate removal surgery) following active surveillance (AS). The authors found that older patients require closer monitoring when on AS and may require additional testing to identify the progression of their disease. 

Prostate cancer (PC) is one of the most common forms of cancer found in men. AS is the monitoring of a disease using blood tests and imaging techniques such as MRI. RP is an operation to remove the prostate gland and tissues surrounding it. Older men often postpone RP and chose AS for the management of early-stage PC to avoid complications that may occur with surgery. However, current guidelines do not factor in patient age in determining a more aggressive testing regimen during AS. 

There were 365 patients with early-stage PC involved in this study. All patients underwent initial AS before having RP. There were 2 patient groups. Group 1 included men aged 65 years and older. Group 2 included men younger than 65 years. The average length of follow-up was 78 months after diagnosis. 

Men in group 1 spent a shorter time on AS (25 months) on average compared to group 2 (35 months). Group 1 was 2.21 times more likely to have poorer pathology findings (grade and type of PC cells) after RP compared to group 2. However, age was not associated with the risk of recurrence after surgery. 

The authors concluded that older men undergoing AS have poorer pathology findings at delayed RP. The authors suggested that additional testing may be required for older patients to chose if they are candidates for AS. 

Not all patients underwent the same testing throughout the study. This may have affected the results.