1030: Do Younger Men have Better Biochemical Outcomes Following Radical Prostatectomy?

Introduction: In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients.Methods: The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy (RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use.Results: There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it.Conclusion: Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem.

Download Full-text

Quality of life in young men after radical prostatectomy: Results from the CaPSURE registry

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.4576 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 4576-4576 ◽

Cited By ~ 1

Author(s):

J. L. Wright ◽

D. W. Lin ◽

J. E. Cowan ◽

J. Duchane ◽

P. R. Carroll ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radical Prostatectomy ◽

Age Groups ◽

Older Men ◽

Multivariate Model ◽

Age Group ◽

Younger Men ◽

One Year

4576 Background: Over the past two decades, the age at diagnosis and treatment of men with prostate cancer (CaP) has steadily declined. Previous work suggests that younger men have similar or improved pathologic and clinical outcomes compared to older men. The literature on quality of life (QOL) following local treatment for CaP has primarily focused on comparing treatment modalities rather than specific age groups. This analysis explored QOL outcomes in younger men following primary curative treatment for localized prostate cancer. Methods: This was a secondary analysis of a prospectively collected cohort from the CaPSURE (Cancer of the Prostate Strategic Urologic Endeavor) registry. Men who underwent radical prostatectomy (RP) for localized disease and completed the UCLA Prostate Cancer Index (PCI) pre- and one-year post-surgery were identified. Men were grouped based on age (< 55, 55–64, ≥ 65 years). A severe decline in PCI domains from pre- to post-RP was defined as a decrease of one standard deviation from the pre-RP score. PCI scores were compared across age groups, and a multivariate model created to analyze the predictors of severe declines in PCI domains. Results: 1,143 men were identified, with 190, 526 and 427 men in the three age groups, respectively. Younger men had significantly higher mean scores one-year after RP in the urinary function (UF), urinary bother (UB) and sexual function (SF) domains of the PCI. The proportion of men with a severe decline in UF, UB and SF was not significantly different in the age groups (range 49–54%, 32–38%, 58–51% respectively). However, a severe decline in SB was more common in the youngest age group than in the oldest (54% vs. 36%, p < 0.01). With the youngest men as the reference group in the multivariate model, the oldest age group was 40% less likely to have a severe decline of SB (OR = 0.60, 95% CI 0.41–0.90, p = 0.04) but trended toward a higher risk of severe decline in UB (OR = 1.27, 95% CI 0.85–1.89, p = 0.08). Conclusions: Age predicts disease-specific QOL changes at one-year following RP. Younger men had significantly better mean UF, UB, and SF domain scores one-year after RP than did their older counterparts. Men < 55 years old are more likely than older men to experience a severe decline of sexual bother but trend toward a lower risk of a severe urinary bother. No significant financial relationships to disclose.

Download Full-text

Advancing age and the risk of adverse pathology at radical prostatectomy in men with biopsy Gleason score 6 prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.289 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 289-289

Author(s):

Daniel Kim ◽

Ming-Hui Chen ◽

Hartwig Huland ◽

Markus Graefen ◽

Derya Tilki ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Cancer Center ◽

Study Cohort ◽

Pathologic Features ◽

Younger Men ◽

Biopsy Gleason Score ◽

The Impact

289 Background: We evaluated the impact of age > 65 years versus younger on the odds of finding adverse pathologic features (pT3/T4 and/or R1 and/or Gleason score 8, 9, 10) at radical prostatectomy (RP) among men with biopsy Gleason score 6 prostate cancer (PC). Methods: The study cohort comprised 3191 men with biopsy Gleason score 6 PC treated with a RP between February 28, 1992 and February 15, 2016 at the Martini-Klinik Prostate Cancer Center. Multivariable logistic regression was used to evaluate the impact of age > 65 years versus younger on the adjusted odds ratio (AOR) of finding adverse pathology at RP adjusting for pre-RP prostate specific antigen (PSA), clinical tumor category, year of diagnosis, percent positive biopsies (PPB), and PSA density (PSAd). Results: Men age > 65 years as compared to younger had significantly lower median PPB (16.67% vs 20.0%; p = 0.01) and PSAd (0.13 ng/mL vs 0.15 ng/mL; p < 0.0001). Yet, while both increasing PPB (AOR 1.018, 95% CI 1.013, 1.023; p- < 0.0001) and PSAd (AOR 4.28, 95% CI 1.66, 11.01; p = 0.003) were significantly associated with an increased odds of finding adverse pathology at RP, men age > 65 years versus younger had a higher odds of adverse pathology at RP (AOR 1.28, 95% CI 1.002, 1.62; p = 0.048). Conclusions: Despite a more favorable median PPB and PSAd, men with biopsy Gleason score 6 PC and who are age > 65 years compared to younger men are at higher risk for having adverse pathology at RP and may benefit from a multiparametric MRI and targeted biopsy before proceeding with active surveillance. If higher grade/stage disease is discovered and treatment indicated then this information could guide both the use and duration of supplemental androgen deprivation therapy in men considering radiation therapy.

Download Full-text

Re: Recovery of Pad-Free Continence in Elderly Men Does Not Differ from Younger Men Undergoing Robot-Assisted Radical Prostatectomy for Aggressive Prostate Cancer

The Journal of Urology ◽

10.1097/ju.0000000000000491 ◽

2019 ◽

Vol 202 (5) ◽

pp. 866-867

Author(s):

Samir S. Taneja

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Elderly Men ◽

Robot Assisted ◽

Aggressive Prostate Cancer ◽

Younger Men

Download Full-text

Geographic, age, and racial variation in the treatment of local/regional carcinoma of the prostate.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.1.93 ◽

1995 ◽

Vol 13 (1) ◽

pp. 93-100 ◽

Cited By ~ 158

Author(s):

L Harlan ◽

O Brawley ◽

F Pommerenke ◽

P Wali ◽

B Kramer

Keyword(s):

Radical Prostatectomy ◽

Black Men ◽

White Men ◽

Geographic Area ◽

Incidence Rates ◽

Clear Trend ◽

Younger Men ◽

Choice Of Treatment ◽

Regional Disease ◽

Age Adjusted Rates

PURPOSE Prostate cancer is one of the most common cancers in men. Incidence rates increase with age and are substantially higher in black men than white men. This study examines the variations in the use of radical prostatectomy and radiation by geographic area, age, and race. MATERIALS AND METHODS Data from the National Cancer Institute's Surveillance, Epidemiology, and End-Results Program (SEER) were used to examine treatment differences. Current treatments generally consist of prostatectomy, radiation, or careful observation for clinically localized or regional disease. RESULTS The age-adjusted proportion of men, age 50 and older, who received radical prostatectomy increased sharply between 1984 and 1991, from 11.0% to 32.3% among men with local/regional disease. The choice of treatment varied widely by geographic regions. In 1991, the proportion that received prostatectomy was highest in Utah (47.8%) and lowest in Connecticut (22.5%) among men with localized and regional disease. The increase in radical prostatectomy was not limited to younger men. Although the rates increased for blacks, black men had lower age-adjusted rates of prostatectomy than whites in all years of the study. CONCLUSION The SEER data show a clear trend toward more aggressive treatment, especially prostatectomy. However, the proportion of black men who received prostatectomy was substantially lower than that of white men and this disparity does not appear to be changing.

Download Full-text