Prostate Surgery Safe for Older Men

Rates of death, complications are low if patient is in good health, study finds

TUESDAY, Oct. 18, 2005 (HealthDay News) -- Removing the prostate in men who have cancer of the gland -- a procedure called radical prostatectomy -- appears to be a safe option for patients up to age 79 who are otherwise healthy, Canadian researchers report.

Prostate cancer is the most common type of cancer that strikes American men, other than skin cancer. It's the second-leading cause of cancer death in men, behind lung cancer, according to the American Cancer Society.

In patients with localized disease, the surgery is associated with lower death rates, lower rates of progression and higher overall survival rates, compared with more conservative approaches, according to the study.

However, few men older than 70 years of age undergo prostate surgery. A recent survey found that 69 percent of Canadian urologists and 53 percent of American urologists believed that age 70 should be the upper limit for the procedure, the researchers said.

"We were interested in understanding whether complications after radical prostatectomy increased as men got older, or as a function of different illnesses that men might have had as they went into surgery," said lead researcher Dr. Shabbir M.H. Alibhai, of the University Health Network and the Toronto Rehabilitation Institute.

The study findings appear in the Oct. 19 issue of the Journal of the National Cancer Institute.

In their study, Alibhai and his colleagues collected data on 11,010 men who underwent prostate surgery in Ontario between 1990 and 1999. The researchers looked at death and complication rates that occurred within 30 days after the procedure.

"We found that the 30-day mortality rate did increase slightly with age," Alibhai said. "The absolute mortality was about 0.5 percent. Although on a relative level there was an increase in the risk of mortality with each decade of age, the absolute risk was still quite low in older men."

Overall, 53 men died, and 2,246 had one or more complications within 30 days of surgery. Other factors that increased the risk of 30-day mortality were previous heart disease or stroke, Alibhai said. "If you had either or both those risks, you were at a significantly higher risk of having 30-day mortality than if you didn't have any of those conditions," he said.

"It's important for physicians and patients to know that if you are thinking about mortality after surgery, that although age is one factor, the presence of heart disease or previous stroke are more important," Alibhai said. "If you are otherwise healthy and you are 79, your mortality risk is quite low."

Alibhai's team did find that increasing age was associated with a higher risk of cardiac complications and a higher risk of respiratory complications and other problems. "But the more medical illnesses you had going into surgery, the more likely you were to be at an increased risk of complications," he said.

"Although age is a player and increases the risk of some complications, it's not as an important predictor of complications as preexisting medical conditions," Alibhai said.

As a result, Alibhai believes age should not be a barrier to prostate surgery.

"If you are going to consider surgery for prostate cancer, it is far more important to think about what other medical conditions you have that may impact on your short-term risk than age," Alibhai said. "If you're 70 or 75, but you are in otherwise good health, you still have low and acceptable risks of complications and that age should not dissuade you from thinking about surgery."

However, Alibhai noted that long-term complications such as urinary incontinence and decreased sexual function after surgery do increase with age. "Older men will be at high risk of these complications, but at the same time you have to weigh the other side," he said. "To date, surgery is probably the most effective therapy for localized prostate cancer."

One expert thinks the results of the study are in line with expectations.

"It's what many of us would have suspected," said Dr. Bruce Roth, a professor of medicine and co-director of the genitourinary oncology program at Vanderbilt University. "It correlates with what we have done in oncology in terms of making chemotherapy decisions, saying that numeric age is not a deciding factor -- it's really physiologic age."

There are some urologists who will never operate on a patient older than 70 because of limited life expectancy, Roth said. "I think those days should go by the wayside," he said. "The decision should be made on the overall health of the patient and expected survival of the patient."

In terms of long-term effects, Roth believes the quality of the surgeon has a lot to do with the outcome. "The more operations you do, the better you get," he said. "And there are probably fewer postoperative complications.

"The key is not to allow a decision to be made in terms of definitive therapy or not definitive therapy or what type of definitive therapy based on numeric age alone," Roth said. "The overall health of the patient is so much more important."

More information

The National Cancer Institute can tell you more about prostate cancer.

SOURCES: Shabbir M. H. Alibhai, M.D., University Health Network and the Toronto Rehabilitation Institute, Ontario, Canada; Bruce Roth, M.D., a professor of medicine and co-director of the genitourinary oncology program at Vanderbilt University, Nashville, Tenn.; Oct. 19, 2005, Journal of the National Cancer Institute
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