How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense — that is, for the benefits to outweigh the risks — you need to be young enough to take advantage of the added survival time that surgery can offer. That’s why I generally don’t recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
Operating by remote control
Many physicians recommend a robotic prostatectomy, shown here, over traditional “open” surgery because the recovery is less taxing. But complications can still occur.
Because many prostate cancers grow so slowly, an older man with the disease may choose active surveillance, which involves following the cancer to see if it advances and causes symptoms. If it does, or if the man prefers to have immediate treatment, radiation therapy can control the disease for years. Hormone therapy can also help.
The bottom line: If your doctor says that you are too old for surgery, don’t despair. Other, less-risky treatments may hold the cancer in check. Talk with your doctor about the options.
SOURCES: Alibhai SM, Leach M, Tomlinson G, et al. Rethinking 30-Day Mortality Risk After Radical Prostatectomy. Urology 2006;68:1057–60. PMID: 17113897.
Thompson RH, Slezak JM, Webster WS, Lieber MM. Radical Prostatectomy for Octogenarians: How Old is Too Old? Urology 2006;68:1042–45. PMID: 17095073.
Originally published July 1, 2009; Last reviewed April 8, 2011