Advertisement

The effect of age at diagnosis on prostate cancer mortality: A grade-for-grade and stage-for-stage analysis

      Abstract

      Objective

      To evaluate the effect of advancing age on cancer-specific mortality (CSM) after radical prostatectomy (RP).

      Materials and methods

      Overall, 205,551 patients with PCa diagnosed between 1988 and 2009 within the Surveillance Epidemiology and End Results (SEER) database were included in the study. Patients were stratified according to age at diagnosis: ≤50, 51–60, 61–70, and ≥71 years. The 15-year cumulative incidence CSM rates were computed. Competing-risks regression models were performed to test the effect of age on CSM in the entire cohort, and for each grade (Gleason score 2–4, 5–7, and 8–10) and stage (pT2, pT3a, and pT3b) sub-cohorts.

      Results

      Advancing age was associated with higher 15-year CSM rates (2.3 vs. 3.4 vs. 4.6 vs. 6.3% for patients aged ≤50 vs. 51–60 vs. 61–70 vs. ≥71 years, respectively; P < 0.001). In multivariable analyses, age at diagnosis was a significant predictor of CSM. This relationship was also observed in sub-analyses focusing on patients with Gleason score 5–7, and/or pT2 disease (all P ≤ 0.05). Conversely, age failed to reach the independent predictor status in men with Gleason score 2–4, 8–10, pT3a, and/or pT3b disease.

      Conclusions

      Advancing age increases the risk of CSM. However, when considering patients affected by more aggressive disease, age was not significantly associated with higher risk of dying from PCa. In high-risk patients, tumor characteristics rather than age should be considered when making treatment decisions.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smith B.D.
        • Smith G.L.
        • Hurria A.
        • Hortobagyi G.N.
        • Buchholz T.A.
        Future of cancer incidence in the United States: burdens upon an aging, changing nation.
        J Clin Oncol. 2009; 27: 2758-2765
        • Spermon J.R.
        • Witjes J.A.
        • Kiemeney L.A.
        Difference in stage and morphology-adjusted survival between young and elderly patients with a testicular germ cell tumor.
        Urology. 2002; 60: 889-893
        • Bechis S.K.
        • Carroll P.R.
        • Cooperberg M.R.
        Impact of age at diagnosis on prostate cancer treatment and survival.
        J Clin Oncol. 2011; 29: 235-241
        • Konety B.R.
        • Cowan J.E.
        • Carroll P.R.
        • CaPSURE Investigators
        Patterns of primary and secondary therapy for prostate cancer in elderly men: analysis of data from CaPSURE.
        J Urol. 2008; 179 ([discussion 803]): 1797-1803
        • Liu D.
        • Lehmann H.P.
        • Frick K.D.
        • Carter H.B.
        Active surveillance versus surgery for low risk prostate cancer: a clinical decision analysis.
        J Urol. 2012; 187: 1241-1246
        • Albertsen P.C.
        • Moore D.F.
        • Shih W.
        • Lin Y.
        • Li H.
        • Lu-Yao G.
        Impact of comorbidity on survival among men with localized prostate cancer.
        J Clin Oncol. 2011; 29: 1335-1341
        • Boorjian S.A.
        • Karnes R.J.
        • Viterbo R.
        • et al.
        Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer.
        Cancer. 2011; 117: 2883-2891
        • Cooperberg M.R.
        • Vickers A.J.
        • Broering J.M.
        • et al.
        Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer.
        Cancer. 2010; 116: 5226-5234
        • Abdollah F.
        • Sun M.
        • Thuret R.
        • et al.
        A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006.
        Eur Urol. 2011; 59: 88-95
        • Briganti A.
        • Spahn M.
        • Joniau S.
        • et al.
        Impact of age and comorbidities on long-term survival of patients with high-risk prostate cancer treated with radical prostatectomy: a multi-institutional competing-risks analysis.
        Eur Urol. 2013; 63: 693-701
        • Siddiqui S.A.
        • Sengupta S.
        • Slezak J.M.
        • et al.
        Impact of patient age at treatment on outcome following radical retropubic prostatectomy for prostate cancer.
        J Urol. 2006; 175: 952-957
        • Sweat S.D.
        • Bergstralh E.J.
        • Slezak J.
        • Blute M.J.
        • Zincke H.
        Competing risk analysis after radical prostatectomy for clinically nonmetastatic prostate adenocarcinoma according to clinical Gleason score and patient age.
        J Urol. 2002; 168: 525-529
        • Malaeb B.S.
        • Rashid H.H.
        • Lotan Y.
        • et al.
        Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts.
        Urol Oncol. 2007; 25: 291-297
        • Lin D.W.
        • Porter M.
        • Montgomery B.
        Treatment and survival outcomes in young men diagnosed with prostate cancer: a Population-based Cohort Study.
        Cancer. 2009; 115: 2863-2871
        • Fine J.
        • Gray R.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Statistician Assoc. 1999; 94: 496-509
        • Gray R.
        A class of K-sample tests for comparing the cumulative incidence of a competing risk.
        Ann Stat. 1988; 16: 1140-1154
        • Scosyrev E.
        • Messing E.M.
        • Mohile S.
        • Golijanin D.
        • Wu G.
        Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality.
        Cancer. 2012; 118: 3062-3070
        • Russo A.L.
        • Chen M.
        • Aizer A.A.
        • Hattangadi J.A.
        • D'Amico A.V.
        Advancing age within established Gleason score categories and the risk of prostate cancer-specific mortality (PCSM).
        BJU Int. 2012; 110: 973-979
        • Tward J.D.
        • Lee C.M.
        • Pappas L.M.
        • Szabo A.
        • Gaffney D.K.
        • Shrieve D.C.
        Survival of men with clinically localized prostate cancer treated with prostatectomy, brachytherapy, or no definitive treatment: impact of age at diagnosis.
        Cancer. 2006; 107: 2392-2400
        • Berger N.A.
        • Savvides P.
        • Koroukian S.M.
        • et al.
        Cancer in the elderly.
        Trans Am Clin Climatol Assoc. 2006; 117 ([discussion 55–6]): 147-155
        • Massengill J.C.
        • Sun M.
        • Moul J.W.
        • et al.
        Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy.
        J Urol. 2003; 169: 1670-1675
        • Brassell S.A.
        • Rice K.R.
        • Parker P.M.
        • et al.
        Prostate cancer in men 70 years old or older, indolent or aggressive: clinicopathological analysis and outcomes.
        J Urol. 2011; 185: 132-137
        • Froehner M.
        • Koch R.
        • Litz R.J.
        • Hakenberg O.W.
        • Oehischlaeger S.
        • Wirth M.P.
        Survival analysis in men undergoing radical prostatectomy at an age of 70 years or older.
        Urol Oncol. 2010; 28: 628-634
        • Dong F.
        • Reuther A.M.
        • Magi-Galluzzi C.
        • Zhou M.
        • Kupelian P.A.
        • Klein E.A.
        Pathologic stage migration has slowed in the late PSA era.
        Urology. 2007; 70: 839-842
        • Resnick M.J.
        • Koyama T.
        • Fan K.H.
        • et al.
        Long-term functional outcomes after treatment for localized prostate cancer.
        N Engl J Med. 2013; 368: 436-445
        • Bill-Axelson A.
        • Holmberg L.
        • Ruutu M.
        • et al.
        Radical prostatectomy versus watchful waiting in early prostate cancer.
        N Engl J Med. 2005; 352: 1977-1984
        • Abdollah F.
        • Suardi N.
        • Cozzarini C.
        • et al.
        Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate Cancer: a long-term survival analysis.
        Eur Urol. 2013; 64: 998-1008
        • Briganti A.
        • Wiegel T.
        • Joniau S.
        • et al.
        Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: results of a match-controlled multi-institutional analysis.
        Eur Urol. 2012; 62: 472-487
        • Gandaglia G.
        • Trinh Q.D.
        • Hu J.C.
        • et al.
        The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the “post-dissemination” period.
        Eur J Surg Oncol. 2014;
        • Yossepowitch O.
        • Briganti A.
        • Eastham J.A.
        • et al.
        Positive surgical margins after radical prostatectomy: a systematic review and contemporary update.
        Eur Urol. 2014; 65: 303-313
        • Boorjian S.A.
        • Karnes R.J.
        • Crispen P.L.
        • et al.
        The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era.
        J Urol. 2010; 183: 1003-1009
        • Mauermann J.
        • Fradet V.
        • Lacombe L.
        • et al.
        The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients.
        Eur Urol. 2013; 64: 19-25
        • Epstein J.I.
        • Allsbrook Jr., W.C.
        • Amin M.B.
        • Egevad L.L.
        • ISUP Grading Committee
        The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason grading of Prostatic Carcinoma.
        Am J Surg Pathol. 2005; 29: 1228-1242