To test the effect of age on cancer-specific mortality (CSM) in most contemporary prostate cancer (PCa) patients of all stages and across all treatment modalities.
Within the Surveillance, Epidemiology, and End Results database (2004–2016), we identified 579,369 PCa patients. Cumulative incidence plots and multivariable competing-risks regression analyses (MCR) were used. Subgroup analyses were performed according to ethnicity (African-Americans), clinical stage (T1-2N0M0, T3-4N0M0, TanyN1M0, and TanyNanyM1), as well as treatment modalities.
Patient distribution was as follows: 142,338 (24.6%) < 60 years; 113,064 (19.5%) 60–64 years; 127,158 (21.9%) 65–69 years; 94,782 (16.4%) 70–74 years; and 102,027 (17.6%) ≥ 75 years. Older patients harbored worse tumor characteristics and more frequently received no local treatment. Overall, 10-year CSM rates were 4.8, 5.3, 5.9, 7.6, and 14.6%, respectively, in patients aged < 60, 60–64, 65–69, 70–74 ,and ≥ 75 years (p < 0.001). In MCR focusing on the overall cohort and T1-2N0M0 patients, older age independently predicted higher CSM, but not in T3-4N0-1M0-1 patients.
Older age was associated with higher grade and stage and independently predicted higher CSM in T1-2N0M0 patients, but not in higher stages. Differences in diagnostics and therapeutics seem to affect elderly patients within T1-2N0M0 PCa and should be avoided if possible.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Bechis SK, Carroll PR, Cooperberg MR (2011) Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 29(2):235–241
Pettersson A, Robinson D, Garmo H, Holmberg L, Stattin P (2018) Age at diagnosis and prostate cancer treatment and prognosis: a population-based cohort study. Ann Oncol 29(2):377–385
Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A et al (2011) A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol 59(1):88–95
Mandel P, Kriegmair MC, Kamphake JK, Chun FK-H, Graefen M, Huland H et al (2016) Tumor characteristics and oncologic outcome after radical prostatectomy in men 75 years old or older. J Urol 196(1):89–94
Bratt O, Folkvaljon Y, Hjälm Eriksson M, Akre O, Carlsson S, Drevin L et al (2015) Undertreatment of men in their seventies with high-risk nonmetastatic prostate cancer. Eur Urol 68(1):53–58
Narayan V, Jiang S, Warlick CA (2017) Early stage cancer in older adults: prostate-avoiding overtreatment and undertreatment. Cancer J Sudbury Mass 23(4):238–241
Lunardi P, Ploussard G, Grosclaude P, Roumiguié M, Soulié M, Beauval JB et al (2017) Current impact of age and comorbidity assessment on prostate cancer treatment choice and over/undertreatment risk. World J Urol 35(4):587–593
Ploussard G, Albrand G, Rozet F, Lang H, Paillaud E, Mongiat-Artus P (2014) Challenging treatment decision-making in older urologic cancer patients. World J Urol 32(2):299–308
About the SEER Program [Internet]. SEER. [cited 2019 Jun 2]. https://seer.cancer.gov/about/overview.html
Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94(446):496–509
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA et al (2016) The 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40(2):244–252
James ND, de Bono JS, Spears MR, Clarke NW, Mason MD, Dearnaley DP et al (2017) Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 377(4):338–351
Chi KN, Agarwal N, Bjartell A, Chung BH, Pereira AJ, Given R et al (2019) Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 381:13–24
Davis ID, Martin AJ, Stockler MR, Begbie S, Chi KN, Chowdhury S et al (2019) Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med 381:121–131
Dell’Oglio P, Boehm K, Trudeau V, Tian Z, Larcher A, Leyh-Bannurah S-R et al (2016) Survival after conservative management versus external beam radiation therapy in elderly patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 96(5):1037–1045
Knipper S, Graefen M (2017) Clinical case discussion: primary treatment for prostate cancer in an elderly man-treatment of the primary tumor is necessary. Eur Urol Focus 3(4–5):326–327
Weischenfeldt J, Simon R, Feuerbach L, Schlangen K, Weichenhan D, Minner S et al (2013) Integrative genomic analyses reveal an androgen-driven somatic alteration landscape in early-onset prostate cancer. Cancer Cell 23(2):159–170
There was no external financial support for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Knipper, S., Pecoraro, A., Palumbo, C. et al. The effect of age on cancer-specific mortality in patients with prostate cancer: a population-based study across all stages. Cancer Causes Control 31, 283–290 (2020). https://doi.org/10.1007/s10552-020-01273-5
- Local treatment
- Radical prostatectomy