Prostate cancer becomes more aggressive with age, could impact screening
MedWire News: Study findings show that as men with prostate cancer age, more aggressive disease characteristics emerge, lessening their chances of survival compared with younger men with the disease.
The findings could have an impact on screening and treatment recommendations, say the researchers.
"There is a conspicuous lack of consensus on the age at which [prostate cancer] screening should cease," comment Stephen Brassell (Walter Reed Army Medical Center, Washington DC, USA) and colleagues.
The American Cancer Society's recommendation for prostate cancer screening is limited to those with a life expectancy of at least 10 years, they add.
The team evaluated survival outcomes (biochemical disease-free, prostate cancer-specific, and overall) in a cohort of 12,081 men with prostate cancer, 3650 of whom were aged 70 years or older.
Overall, clinical disease stage and prediagnosis prostate-specific antigen (PSA) velocity were significantly higher among men aged 70 years or older compared with men in all other age groups (younger than 50 years, 50-59.9 years, 60-69.9 years).
Among men treated with surgery (n=6840), pathological stage, pathological grade, and surgical margin status were also significantly higher in the oldest group of men compared with all other age groups.
Biochemical (PSA) recurrence was more common among men aged 70 years or older, with 49.3% experiencing a PSA recurrence compared with 29.6% of men aged under 50 years. Multivariate analysis confirmed that age 70 years or older was a significant independent predictor of PSA recurrence after surgery, with a hazard ratio of 1.45.
The oldest group of men had the highest risk for prostate cancer-specific mortality, at 3.0% compared with 0.6% for the youngest group, and had the lowest overall survival rates after surgery compared with all other age groups.
Notably, however, the mean time to death after surgery did not differ by age, at 7.6, 7.2, 7.7, and 7.8 years for men aged less than 50 years, 50-59, 60-69, and 70 years or more, respectively.
"The importance of this analysis is to emphasize that older men may have a significant number of life years remaining… they may be genetically predisposed to longevity, and their medical comorbidities may be less, better controlled, or have less impact," conclude Brassell et al in the Journal of Urology.
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By Sarah Guy