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Impact Of Patient Age On Biochemicalrecurrence Rates Following Radical Prostatectomy
Ahmed Magheli*, Soroush Rais-Bahrami*, Bruce J Trock, Mark L Gonzalgo
The Brady Urological Institute, Baltimore, MD
Introduction:
Increased age has been suggested to predict worse clinical outcomes following radical prostatectomy. One explanation is inherent differences in the biological properties of prostate cancer in older men. Stage migration, PSA level, and prostate biopsy pathology are variables that may confound the interpretation of age as an independent prognosticator of outcomes following radical prostatectomy.
Methods:
A matched-pairs analysis was performed comparing three age cohorts: 46-55yrs, 56-65yrs, and ≥ 65yrs matched to a cohort of 435 patients aged ≤45yrs on the basis of propensity scores calculated with all known preoperative variables. Postoperative clinical and pathologic characteristics were compared among the four matched age cohorts. A Cox hazards model was used to compare the time to PSA recurrence across the different age cohorts, and actuarial risk of recurrence was calculated using Kaplan-Meier and log-rank survivor analyses.
Results:
Younger patients exhibited lower grade disease (p<0.001), lower rates of positive surgical margins (p=0.035) and extraprostatic extension (p<0.001), but did not have higher rates lymph node (p=0.85) or seminal vesicle invasion (p=0.56). Kaplan-Meier analysis showed no significant differences in biochemical recurrence across the age cohorts (log-rank=0.38). In multivariable analysis, prostatectomy Gleason score (p<0.001), pathological stage (p<0.001), positive surgical margins (p<0.001), and preoperative PSA (p=0.04) were each independently predictive of biochemical recurrence.
Conclusions:
We demonstrate that increased age is not associated with worse biochemical outcomes following radical prostatectomy and should not be considered an independent prognosticator for disease recurrence. Rather, age is a surrogate for known predictors of biochemical recurrence following surgery.
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