• BJU international · Oct 2014

    Higher rates of upgrading and upstaging in older patients undergoing radical prostatectomy and qualifying for active surveillance.

    • Jonas Busch, Ahmed Magheli, Natalia Leva, Michelle Ferrari, Juergen Kramer, Christian Klopf, Carsten Kempkensteffen, Kurt Miller, James D Brooks, and Mark L Gonzalgo.
    • Department of Urology, Charité University Medicine, Berlin, Germany.
    • BJU Int. 2014 Oct 1; 114 (4): 517-21.

    ObjectiveTo determine pathological and oncological outcomes of patients diagnosed with low-risk prostate cancer in two age cohorts who underwent radical prostatectomy (RP) and qualified for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, as AS for low-risk prostate cancer represents an acceptable management strategy especially for older patients.Patients And MethodsIn all, 320 patients aged ≥65 years who underwent RP and were eligible for AS according to PRIAS criteria were propensity score matched 1:1 to patients aged <65 years. Patient characteristics were compared with chi-square, Kruskal-Wallis, and one-way anova tests. Predictors of RP pathological upgrading or upstaging were analysed using logistic regression. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Predictors of RFS were analysed within Cox regression models.ResultsPathological upgrading and upstaging were significantly higher among older (≥65 years) vs younger (<65 years) patients (53.1% vs 44.1% and 12.2% vs 7.2%, respectively). Higher prostate-specific antigen levels and increasing age were independent predictors of upgrading among patients aged <65 years. There were no differences in RFS or OS between the two age groups. Positive surgical margin status was the only independent predictor of shorter RFS.ConclusionsPatients aged ≥65 years who are eligible for AS by PRIAS criteria have a higher risk of being upgraded and upstaged at RP than those aged <65 years. These findings should be taken into consideration when discussing treatment options for patients diagnosed with prostate cancer.© 2013 The Authors. BJU International © 2013 BJU International.

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