Early oncological and functional outcomes following radical treatment of high-risk prostate cancer in men older than 70 years

A prospective longitudinal study

Catherine Paterson, Abduelmenem Alashkham, Stephen Lang, Ghulam Nabi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. Patients and methods A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20 ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. Results In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO2 retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7% in the surgery group, compared with RT 51.3% and RT and hormone therapy 30.5%, and Kaplan-Meier analysis P<0.001 over 3 years of follow-up Conclusion Radical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared with RT with or without hormones in high-risk men older than 70 years of age. Based on these findings, treatment decisions and surgical therapy should be considered on individual basis in older men with high-risk disease.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalUrologic Oncology: seminars and original investigations
Volume34
Issue number8
DOIs
Publication statusPublished - 1 Aug 2016
Externally publishedYes

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Longitudinal Studies
Prostatic Neoplasms
Prospective Studies
Radiotherapy
Hormones
Prostatectomy
Lymph Node Excision
Therapeutics
Neoadjuvant Therapy
Neoplasm Grading
Kaplan-Meier Estimate
Prostate-Specific Antigen
Leg
Sepsis
Multivariate Analysis
Ischemia
Lymph Nodes
Demography
Databases
Biopsy

Cite this

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title = "Early oncological and functional outcomes following radical treatment of high-risk prostate cancer in men older than 70 years: A prospective longitudinal study",
abstract = "Background Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. Patients and methods A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20 ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. Results In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4{\%}) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO2 retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7{\%} in the surgery group, compared with RT 51.3{\%} and RT and hormone therapy 30.5{\%}, and Kaplan-Meier analysis P<0.001 over 3 years of follow-up Conclusion Radical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared with RT with or without hormones in high-risk men older than 70 years of age. Based on these findings, treatment decisions and surgical therapy should be considered on individual basis in older men with high-risk disease.",
keywords = "Elderly, High risk, Prostate cancer, Radical treatment",
author = "Catherine Paterson and Abduelmenem Alashkham and Stephen Lang and Ghulam Nabi",
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doi = "10.1016/j.urolonc.2016.03.002",
language = "English",
volume = "34",
pages = "1--7",
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TY - JOUR

T1 - Early oncological and functional outcomes following radical treatment of high-risk prostate cancer in men older than 70 years

T2 - A prospective longitudinal study

AU - Paterson, Catherine

AU - Alashkham, Abduelmenem

AU - Lang, Stephen

AU - Nabi, Ghulam

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. Patients and methods A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20 ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. Results In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO2 retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7% in the surgery group, compared with RT 51.3% and RT and hormone therapy 30.5%, and Kaplan-Meier analysis P<0.001 over 3 years of follow-up Conclusion Radical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared with RT with or without hormones in high-risk men older than 70 years of age. Based on these findings, treatment decisions and surgical therapy should be considered on individual basis in older men with high-risk disease.

AB - Background Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. Patients and methods A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20 ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. Results In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had positive surgical margins, and mean lymph nodes dissected were 18.7, SD = 6.7. Further, 5 men experienced postoperative complications in the form of pseudoaneurism of internal iliac branch, leg ischemia, high CO2 retention, and 2 men experienced sepsis. Incidence of biochemical recurrence was significantly lower at 16.7% in the surgery group, compared with RT 51.3% and RT and hormone therapy 30.5%, and Kaplan-Meier analysis P<0.001 over 3 years of follow-up Conclusion Radical surgery with extended lymph nodes dissection appears to have good short-term oncological and functional outcomes compared with RT with or without hormones in high-risk men older than 70 years of age. Based on these findings, treatment decisions and surgical therapy should be considered on individual basis in older men with high-risk disease.

KW - Elderly

KW - High risk

KW - Prostate cancer

KW - Radical treatment

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U2 - 10.1016/j.urolonc.2016.03.002

DO - 10.1016/j.urolonc.2016.03.002

M3 - Article

VL - 34

SP - 1

EP - 7

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 8

ER -