Objective: To assess the perioperative outcome, continence recovery and oncologic outcome of Chinese patients aged 80 years or older treated with radical prostatectomy for prostate cancer.
Methods: We retrospectively evaluated the octogenarian patients who recieved biopsy for prostatic carcinoma and underwent laparoscopic radical prostatectomy from 2007 to 2016. We collected the data of clinical variables, perioperative parameters and postoperative pathological results for the octogenarian patients. We recorded and analyzed the recovery of urinary continence of the patients 3 months, 6 months and 1 year after surgery. Biochemical progression was defined as postoperative prostate specific antigen (PSA) greater than 2 μg/L for 2 times. We evaluated the non-biochemical recurrence survival rate and overall survival rate by Kaplan-Meier survival curve analysis for the patients aged 80 years or older. Multivariable COX regression analyses were used for evaluating the influence factors of biochemical recurrence after laparoscopic radical prostatectomy.
Results: For all the 51 patients, the average age was (81.6±1.6) years,and prebiopsy PSA was (15.19±13.68) μg/L. 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. According to American Society of Anesthesiologists (ASA) classification, grade I was in 6 patients and grade II in 45 patients. All the octogenarian patients received extra-peritoneal laparoscopic radical prostatectomy. The average operation time was (189.6±69.1) min, the estimated blood volume was (169.9±163.5) mL, and 11 patients (21.6%) had 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%) and 4 (7.8%) were pT3a and pT3b. Eight cases (15.7%) presented Gleason score 6,21 cases (41.1%) 7 and 22 cases(43.1%) ≥8. Fourteen cases were positive surgical margin patients after surgery. Overall, the median follow up was 42 months. The continence rate of the octogenarian patients was 64.7%, 82.4% and 92.2% for 3 months, 6 months and 12 months after the surgery. Twelve cases (23.5%) had biochemical recurrence and 4 cases (7.8%) died in the follow up. There was 1 patient who died of prostate cancer progression and 3 died for other reasons. PSA (P=0.019), pT≥T3 (P=0.017) and positive surgical margin (P=0.020) were independent risk factors for biochemical recurrence of the octogenarian prostate cancer patients according to multivariable COX regression analysis.
Conclusion: 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.