Early oncological and functional outcomes following radical treatment of high-risk prostate cancer in men older than 70 years: A prospective longitudinal study

Background: Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years.

Patients and methods: A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20. ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used.

Results: In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO₂ retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7% in the surgery group, compared with RT 51.3% and RT and hormone therapy 30.5%, and Kaplan-Meier analysis P<0.001 over 3 years of follow-up.

Conclusion: Radical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared to radiotherapy with or without hormones in high risk men over 70 years. Based on these findings treatment decisions should be individualised and after considering the health status of each patient.