INTRODUCTION AND OBJECTIVE:
To assess whether advanced age might represent a risk factor for shorter progression-free survival (PFS) in prostate cancer (PCa) patients after robot-assisted radical prostatectomy (RARP).
We examined 8,159 RARP patients stratified according to age groups <70 yrs. (n=7,578) vs. ≥75 yrs. (n=581), before and after propensity score matching (PSM). PSM variables consisted of serum PSA, neoadjuvant androgen deprivation, Charlson Score Comorbidity Index (CCI), year of surgery, pathological Gleason grade (GG), tumor and nodal stage and surgical margins. The same variables, as well as patients’ age, were used for multivariable cox regression analyses (MVA) of PFS, before and after PSM.
Before PSM, older adults harboured statistically significantly greater proportions of unfavourable PCa compared to younger patients: ISUP GG ≥3 (55 vs. 35%; p<0.001), ≥pT3 (53 vs. 34%; p<0.001), pN1 (13 vs. 7.6%; p<0.001) and positive surgical margins (13 vs. 10%, p=0.04). Before PSM, the median follow-up and 3 yr. PFS rates for patients <70 vs. ≥75 yrs. were 60.1 (IQR 24.7-96.6) vs. 35.8 (IQR 5.9-68) months and 84.4 (95%CI 83.5-85.2) vs. 77.3% (95% CI 73.6-81.2), respectively (p<0.001). After PSM, no statistically significant differences in pathological variables between patients were observed. In MVA, age was not a statistically significant risk factor of shorter PFS, neither before nor after PSM.
In the cohort studied, advanced age was associated with more unfavourable PCa characteristics, albeit age itself did not impair patients’ prognosis after RARP. Our findings indicate that RARP in the context of a personalized approach in PCa patients might represent a viable option for the elderly.
Source of Funding:
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors