title: Radical prostatectomy in older men: survival outcomes in septuagenarians and octogenarians.
abstract: OBJECTIVE
  To examine the survival outcomes of septuagenarians and octogenarians (aged > or =80 years) who underwent radical prostatectomy (RP) at our institution, as the US Preventive Services Task Force recently released recommendations that men aged > or =75 years should not be screened for prostate cancer.
  
  
  METHODS
  Our institutional RP database (1982-2008) was queried for men aged > or =70 years at the time of surgery to evaluate actuarial survival after RP; 386 aged 70-81 years (median 71) underwent RP. The median (range) follow-up was 6.5 (1-22) years. Clinicopathological characteristics and mortality data were evaluated; mortality data were gathered through Social Security Administration Death Index and causes of death were confirmed with the Center for Disease Control National Death Index information. Kaplan-Meier analysis was used to evaluate cause-specific survival.
  
  
  RESULTS
  Ten patients (2.6%) had clinical stage T1a-b, 213 (55.3%) had T1c, and 143 (37.1%) had T2 prostate cancer. The median (range) preoperative prostate-specific antigen (PSA) level was 6.2 (0.2-49.9) ng/mL, and the biopsy and pathological Gleason sum was 6 (3-9) and 7 (4-9), respectively. Causes of death included prostate cancer (17), other malignancies (14), cardiovascular causes (14), neurological disease (four), pneumonia (two) and accident (one). The prostate cancer-specific survival rate was 97.6%, 94.0% and 90.2% at 5, 10 and 15 years after RP, respectively; the respective cardiovascular survival rate was 99.5%, 97.6% and 92.5%, and the overall survival rate was 93.1%, 82.5% and 68.9%, respectively.
  
  
  CONCLUSIONS
  If appropriately selected, older men have excellent overall and prostate-cancer specific survival after RP. The benefits of surgery should be weighed against the increased risks of surgical and anaesthetic complications.
authors.affiliation: James Buchanan Brady Urological Institute, Baltimore, MD, USA. philpierorazio@jhmi.edu
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Humphreys
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Misop
authors.initials: M
authors.lastname: Han
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen