Impact of Age at Diagnosis on Prostate Cancer Treatment and Survival

Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA 94143-1695, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 01/2011; 29(2):235-41. DOI: 10.1200/JCO.2010.30.2075
Source: PubMed

ABSTRACT Older men are more likely to be diagnosed with high-risk prostate cancer and to have lower overall survival. As a result, age often plays a role in treatment choice. However, the relationships among age, disease risk, and prostate cancer-specific survival have not been well established.
We studied men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with complete risk, treatment, and follow-up information. High-risk patients were identified by using the validated Cancer of the Prostate Risk Assessment (CAPRA) score. Competing risks regression was used to identify the independent impact of age on cancer-specific survival. We also analyzed the effect of local treatment on survival among older men with high-risk disease.
In all, 26% of men age ≥ 75 years presented with high-risk disease (CAPRA score 6 to 10). Treatment varied markedly with age across risk strata; older men were more likely to receive androgen deprivation monotherapy. Controlling for treatment modality alone, or for treatment and risk, age did not independently predict cancer-specific survival. Furthermore, controlling for age, comorbidity, and risk, older men with high-risk tumors receiving local therapy had a 46% reduction in mortality compared with those treated conservatively.
Older patients are more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy. Indeed, underuse of potentially curative local therapy among older men with high-risk disease may in part explain observed differences in cancer-specific survival across age strata. These findings support making decisions regarding treatment on the basis of disease risk and life expectancy rather than on chronologic age.

Download full-text


Available from: Matthew R Cooperberg, Sep 29, 2015
18 Reads
  • Source
    • "This finding is consistent with previous research (Albertsen et al., 2011; Hall, Jani, Ryu, Narayan, & Vijayakumar, 2005) and may have several explanations. First, individuals with comorbidities may not be treated aggressively for prostate cancer based on perceptions about their life expectancy , ability to tolerate therapy, and potential treatment side effects (Bechis et al., 2011; Post, Hansen, Kil, Janssen-Heijnen, & Coebergh, 2002). Second, side effects or complications are likely to cause interruptions in treatment, which may further lead to increased prostate cancer recurrence (Alibhai et al., 2005; D'Ambrosio et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To identify individual and contextual factors contributing to overall mortality among men diagnosed with prostate cancer in Florida, a random sample of patients (between October 1, 2001, and December 31, 2007) was taken from the Florida Cancer Data System. Patient's demographic and clinical information were obtained from the Florida Cancer Data System. Comorbidity was computed following the Elixhauser Index method. Census-tract-level socioeconomic status and farm house presence were extracted from Census 2000 and linked to patient data. The ratio of urologists and radiation oncologists to prostate cancer cases at the county level was computed. Multilevel logistic regression was conducted to identify significance of individuals and contextual factors in relation to overall mortality. A total of 18,042 patients were identified, among whom 2,363 died. No racial difference was found in our study. Being older at diagnosis, unmarried, current smoker, uninsured, diagnosed at late stage, with undifferentiated, poorly differentiated, or unknown tumor grade were significantly associated with higher odds of overall mortality. Living in a low-income area was significantly associated with higher odds of mortality (p = .0404). After adjusting for age, stage, and tumor grade, patients who received hormonal, combination of radiation with hormone therapy, and no definitive treatment had higher odds of mortality compared with those who underwent surgery only. A large number of comorbidities were associated with higher odds of mortality. Although disease-specific mortality was not examined, our findings suggest the importance of careful considerations of patient sociodemographic characteristics and their coexisting conditions in treatment decision making, which in turn affects mortality.
    American journal of men's health 12/2013; 8(4). DOI:10.1177/1557988313512862 · 1.15 Impact Factor
  • Source
    • "With increasing life expectancy and wide adoption of prostate-specific antigen screening, an increasing number of elderly men are being diagnosed with prostate cancer.2 In addition to prostate-specific antigen and Gleason score, age is considered a key prognostic factor in therapeutic decision-making.3,4 Because of its indolent course and the fact that the majority of patients are diagnosed early, disease progression often occurs many years after the initial diagnosis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The effects of age on clinical presentation, treatment, and outcomes for patients with small-cell carcinoma of the prostate (SCCP) are unclear. A retrospective review was performed on 259 patients who were identified with SCCP in the national Surveillance, Epidemiology, and End Results (SEER) registry from January 1973 to December 2004. The patients were categorized into two groups according to age at diagnosis, ie, younger than 75 years (n = 158, 61%) or 75 years and older (n = 101, 39%). Patient and treatment characteristics and cancer-specific survival were compared between the groups. Multivariate analysis was performed to identify independent prognostic factors associated with cancer-specific survival. The median age of the patients was 72 (30-95) years. There was no significant difference in terms of tumor characteristics, concomitant adenocarcinoma grade, SEER stage, and treatment (including prostatectomy and radiation therapy) received between the groups. Median cancer-specific survival was 19 months (95% confidence interval 13-25). By multivariate Cox proportional hazard modeling, older age group (hazard ratio [HR] 1.95; P = 0.001), concomitant high-grade adenocarcinoma (HR 7.13; P = 0.007), and not having prostatectomy (HR 3.77; P = 0.005) were found to be significant independent predictors of poor cancer-specific survival. Older patients with SCCP had increased risk of poor cancer-specific survival. Whether this age-related poor outcome can be attributed to more aggressive tumor biology in older patients, or is simply a refection of age-related poor performance status and suboptimal chemotherapy needs further investigation.
    Clinical Interventions in Aging 07/2013; 8:871-7. DOI:10.2147/CIA.S44772 · 2.08 Impact Factor
  • Source
    • "The only drawback of the study is the fact that no correlation between outcome and PSA at diagnosis could be made because all patients were identified in the pre-PSA era. A recent analysis of the Cancer of the Prostate Strategic Urologic Research Endeavour database revealed that the likelihood of being diagnosed with high-risk PCa by Cancer of the Prostate Risk Assessment classification 6–10 increased significantly with increasing age ( p < 0.001) [39]. Of these men, 26% of those aged !75 yr presented with high-risk disease at the time of diagnosis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The recommendations and the updated EAU guidelines consider early detection of PCa with the purpose of reducing PCa-related mortality and the development of advanced or metastatic disease. This paper presents the recommendations of the European Association of Urology (EAU) for early detection of prostate cancer (PCa) in men without evidence of PCa-related symptoms. The working panel conducted a systematic literature review and meta-analysis of prospective and retrospective clinical studies on baseline prostate-specific antigen (PSA) and early detection of PCa and on PCa screening published between 1990 and 2013 using Cochrane Reviews, Embase, and Medline search strategies. The level of evidence and grade of recommendation were analysed according to the principles of evidence-based medicine. The current strategy of the EAU recommends that (1) early detection of PCa reduces PCa-related mortality; (2) early detection of PCa reduces the risk of being diagnosed and developing advanced and metastatic PCa; (3) a baseline serum PSA level should be obtained at 40-45 yr of age; (4) intervals for early detection of PCa should be adapted to the baseline PSA serum concentration; (5) early detection should be offered to men with a life expectancy ≥10 yr; and (6) in the future, multivariable clinical risk-prediction tools need to be integrated into the decision-making process. A baseline serum PSA should be offered to all men 40-45 yr of age to initiate a risk-adapted follow-up approach with the purpose of reducing PCa mortality and the incidence of advanced and metastatic PCa. In the future, the development and application of multivariable risk-prediction tools will be necessary to prevent over diagnosis and over treatment.
    European Urology 07/2013; 64(3). DOI:10.1016/j.eururo.2013.06.051 · 13.94 Impact Factor
Show more