Radical prostatectomy in patients aged 75 years or older: review of the literature
Philipp Mandel1, Thenappan Chandrasekar2, Felix K Chun3, Hartwig Huland1, Derya Tilki1,3
1 Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
2 Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario M5G 2M9, Canada
3 Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Source of Support: None, Conflict of Interest: None
Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.