Impact of patient age at treatment on outcome following radical retropubic prostatectomy for prostate cancer

Purpose: Historically young patients with prostate cancer have been found to have poorer outcomes. Recent studies suggest favorable pathological findings and improved survival in younger patients undergoing RRP. We assessed age at treatment as a predictor of post-RRP survival. Materials and Methods: We identified 5,509 patients treated with RRP for prostate cancer at our institution between 1987 and 1995. Age at treatment was classified into categories of younger than 55, 55 to 59, 60 to 64, 65 to 69 and 70 years or older. CSS, sPFS and biochemical PFS were estimated by the Kaplan-Meier method and analyzed using Cox proportional hazard models. Results: Younger patients had lower preoperative prostate specific antigen, and tumor grade and stage. CSS, sPFS and biochemical PFS were similar across age groups but overall survival decreased with older age at treatment. After multivariate adjustment the risk of cancer death was lower in patients 70 years or older (RR 0.53, 95% CI 0.30 to 0.90), while the risk of progression was lower in all age groups compared to that in men younger than 55 years (RR 0.57 to 0.62). On stratified subset analysis sPFS was progressively worse with younger age in patients with high risk pathological findings. However, the addition of age to multivariate models incorporating preoperative prostate specific antigen, pathological features and adjuvant therapy failed to improve their predictive value for CSS. and sPFS. Conclusions: Despite more favorable clinicopathological features younger patients undergoing RRP for prostate cancer have survival similar to that of older counterparts. Given the greater proportionate impact of prostate cancer on survival, it is particularly important to pursue aggressive treatment in younger patients.