Radical prostatectomy for clinically localized prostate cancer in patients aged 75 years or older: comparison with primary androgen deprivation therapy

Figures & data

Table 1. Baseline characteristics.

	RP group (n = 92)	PADT group (n = 99)	p
Age (years)	76.0 (75.0–77.0)	79.6 (77.0–82.0)	<.001
Prebiopsy PSA (ng/mL)	6.97 (4.84–14.20)	9.69 (6.05–14.97)	.012
Biopsy Gleason score			.353
≤6	35 (38.0%)	34 (34.3%)
7	40 (43.5%)	38 (38.4%)
≥8	17 (18.5%)	27 (27.3%)
Clinical T stage			.909
cT1	19 (20.7%)	23 (23.2%)
cT2a	34 (37.0%)	39 (39.4%)
cT2b	12 (13.0%)	12 (12.1%)
cT2c	27 (29.3%)	25 (25.3%)
ECOG performance status grade			<.001
0	44 (47.8%)	35 (35.4%)
1	47 (51.1%)	44 (44.4%)
≥2	1 (1.1%)	20 (20.2%)
Charlson comorbidity index score			.507
0	57 (62.0%)	59 (59.6%)
1	22 (23.9%)	20 (20.2%)
≥2	13 (14.1%)	20 (20.2%)

Values are presented as median (inter-quartile range), or number (%).

PADT: primary androgen deprivation therapy; ECOG: Eastern Cooperative Oncology Group; PSA: prostate-specific antigen; RP: radical prostatectomy.

Figure 1. Survival analysis according to primary treatment modality. (A) Cancer-specific survival. (B) Overall survival. PADT: primary androgen deprivation therapy, RP: radical prostatectomy.

Table 2. Post-treatment complications.

	RP group (n = 92)	PADT group (n = 99)	p
Urinary incontinence	30 (32.6%)	0 (0.0%)	<.001
New-onset erectile dysfunction	41 (44.6%)	23 (23.2)	.002
Bladder neck contracture or urethral stricture	5 (5.4%)	0 (0.0%)	.024
Hernia	12 (13.0%)	0 (0.0%)	<.001
Hot flush	2 (2.2%)	12 (12.1%)	.008
Sweating	0 (0.0%)	6 (6.1%)	.029
Mastalgia or gynecomastia	4 (4.3%)	11 (11.1%)	.083
Serious adverse events^a	1 (1.1%)	13 (13.1%)	.001
Cardio- or cerebrovascular event	1 (1.1%)	8 (8.1%)	.036
Bone fracture	0 (0.0%)	5 (5.1%)	.060

Values are presented as number (%).

PADT: primary androgen deprivation therapy; RP: radical prostatectomy.

^a Serious adverse events: cardio- or cerebrovascular accident, or bone fracture.

Table 3. Univariable and multivariable analysis for prediction of serious adverse events.^a

	Univariable analysis			Multivariable analysis
	OR	(95% CI)	p	OR	(95% CI)	p
Age	1.20	(1.05–1.36)	.007	1.06	(0.91–1.25)	.455
Prebiopsy PSA level^b	1.48	(0.83–2.63)	.180	1.31	(0.68–2.52)	.422
Biopsy Gleason score (≥8 vs. ≤7)	1.97	(0.62–6.21)	.249	1.77	(0.51–6.19)	.373
Clinical T stage (cT2c vs. ≤ cT2b)	2.14	(0.70–6.48)	.180	1.94	(0.58–6.54)	.285
ECOG performance status grade (≥1 vs. 0)	1.29	(0.42–4.02)	.657	1.10	(0.31–3.90)	.882
Charlson comorbidity index score (≥1 vs. 0)	2.19	(0.73–6.58)	.163	2.53	(0.73–8.70)	.142
Primary treatment option (PADT vs. RP)	13.76	(1.76–107.41)	.012	10.12	(1.14–90.10)	.038

ECOG: Eastern Cooperative Oncology Group; PADT: primary androgen deprivation therapy; PSA: prostate-specific antigen; RP: radical prostatectomy.

^a Serious adverse events: cardio- or cerebrovascular accident, or bone fracture.

^b Log-transformed values were used for analysis.

Table 4. Studies on radical prostatectomy for patients aged 75 years or older.

Study	Year of publication	N	Patients
Xylinas et al. [18]	2010	22	LRP, Age >75 years (single arm)
Labanaris et al. [19]	2012	45	RALRP, Age ≥75 years
		2000	RALRP, Overall cohort
Ryu et al. [16]	2016	89	RP, Age ≥75 years
		168	RP, Age 65–69 years
Mandel et al. [17]	2016	265	RP, Age ≥75 years
		13,732	RP, Age <75 years

LRP: laparoscopic RP; RALRP: robotic assisted laparoscopic RP; RP: radical prostatectomy.

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