Introduction/background: Although surgery is less commonly selected as treatment for localized prostate cancer (PCa) as patients age, outcomes among older patients treated with radical prostatectomy remain unclear. The objective of this study was to compare survival across non-definitive therapy (NDT), radiotherapy, and radical prostatectomy (RP) among men older than 80 years old.

Materials and methods: Using the SEER-17 database, we identified patients ≥80 years at diagnosis with localized prostate cancer in 2000-2021 who were initially managed with NDT, radiotherapy, or RP. We compared overall (OS) and prostate cancer-specific survival (PCSS).

Results: We identified 53,437 patients with PCa≥80 years including 35,728 (68.2%) who underwent NDT, 15,906 (30.4%) treated with radiotherapy, and 736 (1.4%) with RP. The median age was 83 years (IQR: 81-85) and median PSA at diagnosis was 10.7 ng/mL (IQR: 6.7-19.9). Median OS was 66, 102 and 116 months for patients managed with NDT, radiotherapy, and RP, respectively (OS-P<0.01, PCSS-P<0.01). Cox regression revealed that compared to NDT, radiotherapy (OS-baseline adjusted hazard ratio: 0.48, 95% CI: 0.45-0.51, P<0.01; PCSS-baHR: 0.44, 95% CI: 0.38-0.51, P<0.01) and RP were associated with higher OS and PCSS (OS-baHR: 0.33, 95% CI: 0.24-0.46, P<0.01; PCSS-baHR: 0.19, 95% CI: 0.08-0.42, P<0.01).

Conclusion: These findings suggest that well-selected patients ≥80 years may experience favorable survival following RP.

Keywords: Prostate cancer; elderly; non-definitive therapy; radical prostatectomy; radiotherapy.

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