Search

Backround: Accurate life expectancy estimation is crucial in clinical decision-making including management and treatment of clinically localized prostate cancer (PCa). Objective: We hypothesized that Social Security Administration (SSA) life tables’ derived survival estimates closely follow observed survival of PCa patients. To test this relationship, we examined 10-yr overall survival rates in patients with clinically localized PCa and compared it with survival estimates derived from the SSA life tables. Patients and methods: Within the Surveillance, Epidemiology, and End Results database (2004), we identified patients aged >50– < 90 yr. Follow-up was at least 10 yr for patients who did not die of disease or other causes. Outcome measurements and statistical analysis: Monte Carlo method was used to define individual survival in years, according to the SSA life tables (2004–2014). Subsequently, SSA life tables’ predicted survival was compared with observed survival rates in Kaplan-Meier analyses. Subgroup analyses were stratified according to treatment type and D'Amico risk classification. Results and limitations: Overall, 39 191 patients with localized PCa were identified. At 10-yr follow-up, the SSA life tables’ predicted survival was 69.5% versus 73.1% according to the observed rate (p < 0.0001). The largest differences between estimated versus observed survival rates were recorded for D'Amico low-risk PCa (8.0%), brachytherapy (9.1%), and radical prostatectomy (8.6%) patients. Conversely, the smallest differences were recorded for external beam radiotherapy (1.7%) and unknown treatment type (1.6%) patients. Conclusions: Overall, SSA life tables’ predicted life expectancy closely approximate observed overall survival rates. However, SSA life tables’ predicted rates underestimate by as much as 9.1% the survival in brachytherapy patients, as well as in D'Amico low-risk and radical prostatectomy patients. In these patient categories, an adjustment for the degree of underestimation might be required when counseling is provided in clinical practice. Patient summary: Social Security Administration (SSA) life tables’ predicted life expectancy closely approximate observed overall survival rates. However, SSA life tables’ predicted rates underestimate by as much as 9.1% the survival in brachytherapy patients, as well as in D'Amico low-risk and radical prostatectomy patients. Social Security Administration life tables’ predicted life expectancy closely approximate observed survival rates. However, life tables’ predicted rates underestimate by as much as 9.1% the overall survival in brachytherapy patients as well as in D'Amico low-risk and radical prostatectomy patients.

Radical prostatectomy (RP) represents one standard of care for patients with localized prostate cancer and is associated with several established postoperative complications.We tested the relationship between RP early postoperative outcomes and age within a population-based data repository.Within the National Inpatient Sample database (2008-2013), we identified patients who underwent robotically assisted or open RP.Multivariable logistic regression (MLR), multivariable Poisson regression (MPR), and linear regression models were used. Cubic spline graphically depicted the relationship between age and complications.Overall, 68780 patients underwent RP with a median age of 62 yr (interquartile range: 57-67 yr). In MLR models, patient age represented an independent predictor of overall [odds ratio (OR): 1.02, p0.001], intraoperative (OR: 1.03, p0.001), cardiac (OR: 1.03, p0.001), miscellaneous medical (OR: 1.02, p0.001), miscellaneous surgical (OR: 1.01, p=0.01), pulmonary (OR: 1.02, p0.001), and vascular complications (OR: 1.05, p0.001); blood transfusions (OR: 1.02, p0.001); and bowel obstruction (OR: 1.02, p0.001). In MPR models, patient age was associated with longer stay (OR: 1.001, p=0.02). Similar results were recorded after adjustment for clustering in stratified analyses (70 vs ≥70 yr) and in the subgroup of patients that underwent robotically assisted RP. For nine out of twelve examined outcomes, a virtually direct relationship existed with increasing age, in cubic spline analyses.Virtually all early postoperative RP complications are directly related to age. In consequence, these observations should be considered from an individual patient perspective as well as from a health management perspective.RP is provided through a wide patient age spectrum. Virtually all early postoperative RP complications are directly related to age. Individual patient's age needs to be considered in treatment decision-making.

Background: Historically, partial nephrectomy (PN) showed no benefit on other-cause mortality (OCM) in elderly patients with small renal masses. Objective: To test the effect of PN versus radical nephrectomy (RN) on OCM, cancer-specific mortality (CSM), as well as 30-d mortality in patients with nonmetastatic T1a renal cell carcinoma (RCC), aged ≥75 yr old. Design, setting, and participants: Within the Surveillance, Epidemiology and End Results registry (2004-2014), we identified surgically treated patients with nonmetastatic pT1a RCC aged ≥75 yr. Outcome measurements and statistical analysis: We relied on propensity score (PS) matching to reduce the effect of inherent differences between PN and RN. After PS matching, cumulative incidence, multivariable competing-risks regression (CRR) and logistic regression models were used. LOESS plots graphically depicted the relation between nephrectomy type and OCM after adjustment for all the covariates. Landmark analyses at 6 mo tested for immortal time bias. Results and limitations: Of all 4541 patients, 41.6% underwent PN. After 1:1 PS matching, 2826 patients remained. In multivariable CRR models, lower OCM rates were recorded in PN patients (hazard ratio [HR]: 0.67, confidence interval [CI]: 0.54-0.84; p< 0.001). LOESS plots showed lower OCM rates after PN across all examined ages. Lower CSM rates were also recorded in PN patients (HR: 0.64, CI = 0.44-0.92; p = 0.02). Landmark analyses rejected the hypothesis of immortal time bias. Finally, PN did not result in different 30-d mortality rates (odds ratio: 1.87; CI: 0.79-4.47; p = 0.2) versus RN. Data are retrospective. Conclusions: PN results in lower OCM in elderly patients with pT1a RCC. Moreover, PN does not contribute to higher CSM or 30-d mortality in patients aged ≥75 yr. In consequence, PN should be given strong consideration, even in elderly patients. Patient summary: Partial nephrectomy (PN) may protect from renal insufficiency, hypertension, and other unfavorable health outcomes, even in elderly patients. This protective effect results in lower other-cause mortality. Moreover, PN benefits are not undermined by higher cancer-specific mortality or 30-d mortality. Partial nephrectomy should be given strong consideration even in elderly patients.