Malaeb Bahaa S, Rashid Hani H, Lotan Yair, Khoddami Seyyed M, Shariat Shahrokh F, Sagalowsky Arthur I, McConnell John D, Roehrborn Claus G, Koeneman Kenneth S
Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA.
Urol Oncol. 2007 Jul-Aug;25(4):291-7. doi: 10.1016/j.urolonc.2006.08.001.
To evaluate the feasibility of radical retropubic prostatectomy (RRP) as an option for treating men older than 70 years with organ confined prostate cancer and to compare biochemical progression-free survival with younger cohorts.
A total of 689 consecutive patients who were treated with RRP from 1994 to 2002 for clinically localized prostate cancer were categorized into 3 different age groups: younger than 50 years (n = 49), 50-70 years (n = 601), and older than 70 years (n = 39). Patients older than 70 years were healthy individuals for their age. Preoperative and postoperative cancer-specific characteristics were compared among these 3 groups.
There was no statistical significant difference among the 3 age strata in terms of clinical parameters (prostate-specific antigen, Gleason score, clinical stage, percent and number of positive biopsy cores) and pathologic findings (surgical margin, lymph node status, extracapsular extension, lymphovascular invasion, and pathologic Gleason score). The rate of seminal vesicle invasion and prostate volume increased with advancing age (P = 0.034 and P < 0.001). In multivariate logistic regression analysis, age was not associated with seminal vesicle invasion. The 5-year prostate-specific antigen progression-free estimates for patients younger than 50, 50-70, and older than 70 years were 82% (95% confidence interval [CI] 69% to 96%), 82% (95% CI 78% to 86%), and 65% (95% CI 43% to 86%), respectively (P = 0.349). The overall and cause-specific mortalities were not different.
RRP could be considered a standard treatment option in men older than 70 years with localized prostate cancer. Further studies are necessary to assess the survival benefit and health-related quality of life after radical prostatectomy versus watchful waiting in patients older than 70 years.
评估耻骨后根治性前列腺切除术（RRP）作为治疗70岁以上局限性前列腺癌男性患者的一种选择的可行性，并比较其与年轻队列的无生化进展生存期。
1994年至2002年期间共689例因临床局限性前列腺癌接受RRP治疗的连续患者被分为3个不同年龄组：小于50岁（n = 49）、50 - 70岁（n = 601）和大于70岁（n = 39）。70岁以上患者在其年龄组中身体状况良好。比较这3组患者术前和术后的癌症特异性特征。
在临床参数（前列腺特异性抗原、Gleason评分、临床分期、阳性活检核心的百分比和数量）和病理结果（手术切缘、淋巴结状态、包膜外侵犯、淋巴管浸润和病理Gleason评分）方面，3个年龄层之间无统计学显著差异。精囊侵犯率和前列腺体积随年龄增长而增加（P = 0.034和P < 0.001）。在多因素逻辑回归分析中，年龄与精囊侵犯无关。小于50岁、50 - 70岁和大于70岁患者的5年无前列腺特异性抗原进展估计值分别为82%（95%置信区间[CI] 69%至96%）、82%（95% CI 78%至86%）和65%（95% CI 43%至86%）（P = 0.349）。总死亡率和病因特异性死亡率无差异。
RRP可被视为70岁以上局限性前列腺癌男性患者的标准治疗选择。有必要进一步研究评估70岁以上患者根治性前列腺切除术后与密切观察等待相比的生存获益和健康相关生活质量。
