Perioperative parameters and prognosis analysis of patients aged 80 years old or older treated with radical prostatectomy for prostate cancer
To assess the perioperative outcome, continence recovery and oncologic outcome of Chinese patients aged 80 years old or older treated with radical prostatectomy for prostate cancer.
We retrospectively evaluated the octogenarian patients from 2007 to 2016 who were biopsy proved prostatic carcinoma and performed laparoscopic radical prostatectomy . We collected the data of clinical variables, perioperative parameters and postoperative pathological results for octogenarian patients. After surgery we recorded and analyzed recovery of urinary continence of patients at 3 months, 6 months and 1 year after surgery. Biochemical progression was defined as postoperative PSA greater than 2ng/ml for 2 times. We evaluated the no biochemical recurrence survival rate and overall survival rate by Kaplan-Meier survival curve analysis for patients aged 80 year old or older. Mmultivariable Cox regression analyses was used for evaluating the influence factors of biochemical recurrence after laparoscopic radical prostatectomy.
For all 51 patients, the average age was 81.6±1.6, pre-biopsy PSA was 15.19±13.68ng/ml. There were 14 cases(27.5%), 19 cases(37.3%) and 18 cases(35.3%) for biopsy Gleason score 6, 7 and ?8. There were 6 patients(11.8%) with clinical stage T1, 31 patients(60.8%)with clinical stage T2 and 14 patients(27.5%) with clinical stage T3.All octogenarian patients was received extra-peritoneal laparoscopic radical prostatectomy. The average operation time was 189.6±69.1min, the estimated blood volume was 169.9±163.5ml, 11 patients(21.6%) has perioperative complications. There were 29 cases(56.9%) and 22 cases(43.1%) staged for pT2 and pT3 based on postoperative pathological test. Of the pT3 patients, 18(35.3%) cases and 4(7.8%) cases were pT3a and pT3b.8 cases(15.7%) presented Gleason score 6,21 cases(41.1%) for 7 and 22 cases(43.1%) for ?8. 14 cases were positive surgical margin patients after surgery. Overall, the average follow up was 45.9 months. The continence rate of octogenarian patients was 64.7%, 82.4% and 92.2% for 3 months, 6 months and 12 months after the surgery.12 cases(23.5%) had biochemical recurrence and 4 cases(7.8%) died in follow up. There was 1 case died caused by prostate cancer progression and 3 cases for other reasons. PSA(p=0.019), pT?T3(0.020) and positive surgical margin(p=0.021) were independent risk factors for biochemical recurrence of octogenarian prostate cancer patients according to multivariable COX regression analysis.
For well selected octogenarian prostate cancer patients, laparoscopic radical prostatectomy was a feasible treatment option. Octogenarian patients who received laparoscopic radical prostatectomy showed good oncologic outcome. PSA, pT?T3 and positive surgical margin were independent risk factors for biochemical recurrence of octogenarian prostate cancer patients.