Radical retropubic prostatectomy for prostate cancer in the elderly and the young: complications and prognosis.

Abstract

The young and the elderly patients with surgically resectable prostate cancer require considerations unique to their age group. From 1966 to 1988, 191 patients who were < or = 55 years old and 51 elderly patients who were > or = 75 years old underwent radical retropubic prostatectomy. Compared with younger patients, elderly patients had a higher pathologic stage (71 versus 45% stage pT3 or greater, p < 0.001) and higher-grade lesions (49 versus 21%, p < 0.001). Survival was significantly worse compared with age-matched controls for younger patients with high-stage or high-grade lesions (p < 0.001). No elderly patients died within the first 5 years after hospital dismissal. Two thirds of elderly as well as younger patients had no perioperative complications. Significant urinary incontinence occurred in 16% of the elderly compared with 3% of the younger patients (p = 0.001) at 1 year. These data reflect our philosophy of using surgical treatment for patients with unfavorable, large-volume disease even when patients are elderly; if well-selected, these patients can have excellent survival. The observed higher incontinence rate in the elderly should be part of the discussion with the patient before operation.