Mandel Philipp, Chandrasekar Thenappan, Chun Felix K, Huland Hartwig, Tilki Derya
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany.
Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario M5G 2M9, Canada.
Asian J Androl. 2017 Sep 26;21(1):32-6. doi: 10.4103/aja.aja_43_17.
Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.
鉴于人口趋势显示预期寿命将大幅延长，在未来几十年中，老年前列腺癌患者的比例将进一步增加。因此，问题来了，是否应该为75岁及以上的患者提供根治性前列腺切除术，以及在何种情况下提供？对于治疗决策而言，预期寿命比生理年龄更重要。因此，必须确定患者的健康和精神状态，并且仅应向身体状况良好的患者提供根治性治疗。由于这些患者围手术期的发病率和死亡率相对于年轻患者有所增加，根据合并症进行患者选择是一个需要解决的关键问题。从文献中可知，老年男性的肿瘤特征明显更差，导致治疗后的肿瘤学结果更差。此外，老年患者术后控尿和勃起功能的恢复也较差。由于75岁及以上患者的肿瘤学和功能结果的绝对发生率仍然非常合理，因此可以为经过严格挑选且健康的老年患者提供根治性前列腺切除术。然而，显然需要告知患者，与年轻患者相比，他们的结果更差，围手术期风险更高。
