Introduction: Despite increasing evidences supporting the oncologic efficacy of the removal of entire gland especially by the robot-assisted radical prostatectomy (RARP) in advanced or high-risk prostate cancer, little is known about the role of surgery in the elderly patient who have limited life expectancy within 10 years. Considering contemporary average life span in Korean male of 79.7 years (2017), we compared the overall mortality of RARP and radiation (RT) in men older than 70 years in localized/locally advanced disease.
Methods: Among the newly registered prostate cancer patient in each year between 2006 to 2016 using the data from National Health Insurance Sharing Service (NHISS), elderly men (=70 yrs) who were treated with RARP or RT were selectively enrolled. Patients with more than 6 months of androgen deprivation therapy (ADT) before RT, and direct therapy on metastatic lesions were excluded. The primary end point was overall survival regardless of cause of death, which was not described in current version of NHISS.
Results: Among 139,682 newly coded patients during study period, 13,952 elderly patients had RARP (N=7,535) or RT (N=6,417). The patient with RARP was younger than that for RT (73.81±3.58 vs. 75.05±3.83 yrs, p<.001), but all the other variables including age, income, residence area, and co-morbidities including DM, hypertension and dyslipidemia which potentially effect on mortality were similar. The death rate adjusted for all of the variables was significantly lower in RARP than RT patients (HR=.767, 95% CI .072-.818, p<.0001). From the age of 75 yrs, more patients underwent RT (N=3,239) rather than RARP (N=2,478). The adjusted death rate for this particular patients was similar (HR=.98, 95% CI .897-1.07, p=.649). When adjuvant therapy was excluded from each modality (ADT from RT group and RT from RARP group), the adjusted mortality rate was significantly lower in RARP group regardless of age cut-off.
Conclusions: With limitation of population based study provided by medical insurance information, RARP performed in elderly patients seems to be an efficient therapeutic option replacing RT which had long been recommend for this particular age group of patients, providing similar survival for patients older than 75 yrs and superior survival for relatively younger counterparts (70-74 yrs). Source of
