Is prostate surgery beneficial for older men with additional medical conditions?

This study examined the benefits of prostate surgery among older men with high-risk prostate cancer and additional medical conditions. Researchers concluded that prostate surgery is a suitable treatment option for older high-risk prostate cancer patients with few additional medical conditions.

Surgical removal of the prostate gland (also called radical prostatectomy) is a common treatment for localized prostate cancer. Advances in technology have led to prostate surgeries being more efficient and easier to tolerate. This has allowed for a more widespread use.

A number of studies have reported good treatment outcomes following prostate surgeries among men with increased risk of cancer recurrence (high-risk prostate cancer). However, prostate surgery may not be a suitable option for all men, such as men with shorter life expectancies due to additional medical conditions (also called comorbidities). 

The aim of this study was to evaluate the survival benefit of prostate surgery among older men with comorbidities.

This study included 1,008 men aged 70 years or older with high-risk prostate cancer. 93% of these men had comorbidities that were lower severity. 7% had comorbidities of higher severity (associated with shorter life expectancies). Clinical and cancer characteristics were similar between the two groups. All men underwent radical prostatectomy with removal of local lymph nodes.

Overall, prostate surgery was effective in older men. 10-year cancer-related mortality rates were low. However, 10-year mortality rates due to other causes were higher in patients with more severe comorbidities (33.6%) compared to patients with less severe comorbities (21.2%). 

Researchers concluded that older men with high-risk prostate cancer and severe comorbidities are at increased risk of mortality from any cause, and may therefore not be suitable candidates for prostate surgery.