Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Prostate. 2013 Jun;73(8):897-903. doi: 10.1002/pros.22635. Epub 2012 Dec 31.
Consensus on prostate cancer (PCA) treatment in older men is currently lacking. We evaluated clinicopathological and oncological outcomes in patients >70-year-old treated with radical prostatectomy (RP).
Clinicopathological and follow-up (FU) data for >70-year-old RP men (2000-2011) were recorded. Association between preoperative features, extraprostatic extension (EPE) and biochemical failure (bF), and postoperative features and bF, was explored. Patients >70-year-old were matched with younger (50- to 70-year-old) men with similar RP features to analyze the effect of age on bF.
Two hundred eighteen RP patients were >70-year-old. Clinical stage (cT) was T1 in 74.1%. Biopsy (Bx) Gleason score (GS) was 6 (35.8%), 7 (45.9%), and ≥8 (18.3%); RP GS was 6 (10.1%), 7 (63.3%), and ≥8 (26.6%). Median PSAD was 0.14 (range: 0.01-1.12). Pathologic stage (pT) was pT3 in 45.9%. bF occurred in 14.0%. Best preoperative predictive model for pT3 disease included D'Amico risk, number of Bx positive cores, PSAD, maximum % of PCA per core (P < 0.0001); cT, PSAD and primary Bx Gleason pattern best predicted bF preoperatively (P = 0.0031). Among postoperative features, high RP GS, positive margins, and pT3 were significantly associated with bF. Margin status and pT best predicted bF. Patients >70-year-old had 85% higher odds of bF compared to younger men (P = 0.036).
PCA detected in >70-year-old men shows adverse pathologic features. Failure rate is significantly higher in older than in matched younger patients.
目前，对于老年男性前列腺癌（PCA）的治疗尚无共识。我们评估了行根治性前列腺切除术（RP）的>70 岁患者的临床病理和肿瘤学结局。
记录了>70 岁行 RP 男性（2000-2011 年）的临床病理和随访（FU）数据。探讨了术前特征、前列腺外扩展（EPE）和生化失败（bF）之间的关系，以及术后特征和 bF 之间的关系。对>70 岁的患者与具有相似 RP 特征的年轻（50-70 岁）男性进行匹配，以分析年龄对 bF 的影响。
218 例 RP 患者年龄>70 岁。临床分期（cT）为 T1 的占 74.1%。活检（Bx）Gleason 评分（GS）为 6（35.8%）、7（45.9%）和≥8（18.3%）；RP GS 为 6（10.1%）、7（63.3%）和≥8（26.6%）。中位 PSA 密度（PSAD）为 0.14（范围：0.01-1.12）。病理分期（pT）为 pT3 的占 45.9%。bF 发生率为 14.0%。预测 pT3 疾病的最佳术前预测模型包括 D'Amico 风险、Bx 阳性核心数、PSAD、每个核心中 PCA 的最大百分比（P<0.0001）；cT、PSAD 和原发性 Bx Gleason 模式最好地预测了术前 bF（P=0.0031）。在术后特征中，高 RP GS、阳性切缘和 pT3 与 bF 显著相关。切缘状态和 pT 最好地预测了 bF。与年轻男性相比，>70 岁的患者发生 bF 的可能性高 85%（P=0.036）。
在>70 岁男性中检测到的 PCA 显示出不良的病理特征。与匹配的年轻患者相比，老年患者的失败率明显更高。
