UroToday- In the November issue of the Journal of Urology, Dr. Magheli and associates are the first to use propensity scores to evaluate the impact of patient age on biochemical recurrence following radical prostatectomy (RP).

Propensity scoring is a method to match members of different groups based on a range of clinical and pathologic characteristics. Multivariate logistic regression analysis is used to control for imbalances in confounding factors among discrete study cohorts and continuous and categorical factors are combined to yield a propensity score for each individual. Between 1984 and 2006, 14,800 men underwent RP at Johns Hopkins University and 435 made up the study cohort of men under age 45 years. Three other cohorts ages 46 to 55, 56 to 65, and older than 65 were matched to the under 45 year old group. A total of 1,740 men comprised the entire study cohort.

There were no differences regarding preoperative variables used for propensity score matching, to include preoperative PSA, Gleason score and tumor stage. Postoperative variables revealed that younger patients had higher rates of lower Gleason grade disease and fewer positive surgical margins and extra-prostatic extension. Age was not associated with lymph node metastasis or seminal vesicle invasion. The investigators found on multivariate analysis that prostatectomy Gleason score, pathological stage, positive surgical margins, and preoperative PSA were predictive of biochemical recurrence after RP. The 5 and 10-year biochemical free survival rates were 91% and 85% for all patients in the study. Age stratification demonstrated that the group younger than 45 years, 46 to 55, 56 to 65, and greater than 65 had 5 and 10-year biochemical-free survival rates of 93% and 89%, 89% and 85%, 89% and 84%, and 89%, and 78%, respectively. No significant differences were found in time to PSA recurrence following surgery in any age group.

In summary, the researchers report that younger patients have lower prostatectomy Gleason scores and less extra-prostatic extension and positive surgical margins than older men. However, despite this advantage, there we no statistically significant difference in biochemical-free survival among the different age cohorts studied.

Magheli A, Rais-Bahrami S, Humphreys EB, Peck HJ, Trock BJ, Gonzalgo ML

J Urol. ePub: September 14, 2007
doi:10.1016/j.juro.2007.07.016

Reported by UroToday Contributing Editor Christopher P. Evans, M.D

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