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


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.

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    • "These patients with early-onset prostate cancer were however more likely to have low-grade cancers than their older counterparts. Similarly, Bechis et al. (2011) found that older patients were more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy. Scosyrev et al. (2011) also reported that men aged 75 years and older were more likely to have advanced prostate cancer because of more aggressive disease (e.g. "
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    ABSTRACT: Individual-level data from the Florida Cancer Data System (1981–2007) were analyzed to explore temporal trends of prostate cancer late-stage diagnosis, and how they vary based on race, income and age. Annual census-tract rates were computed for two races (white and black) and two age categories (40–65, >65) before being aggregated according to census tract median household incomes. Joinpoint regression and a new disparity statistic were applied to model temporal trends and detect potential racial and socio-economic differences. Multi-dimensional scaling was used as an innovative way to visualize similarities among temporal trends in a 2-D space. Analysis of time-series indicated that late-stage diagnosis was generally more prevalent among blacks, for age category 40–64 compared to older patients covered by Medicare, and among classes of lower socio-economic status. Joinpoint regression also showed that the rate of decline in late-stage diagnosis was similar among older patients. For younger patients, the decline occurred at a faster pace for blacks with rates becoming similar to whites in the late 1990s, in particular for higher incomes. Both races displayed distinct spatial patterns with higher rates of late-stage diagnosis in the Florida Panhandle for whites whereas high rates clustered in South-eastern Florida for blacks.
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    • "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). "
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    • "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. "
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