Grade and Stage (risk) Increases with Age

[alanbarlee]

Published in Oncology

News · May 21, 2015

In a Group of Over 200 Men Age 70+, Prostate Cancer Was Not Innocuous

 

May 20, 2015—New Orleans, Louisiana—In a retrospective study covering 9 years, more than half of men age 70 years and older with prostate cancer had high-risk disease. This outcome of a retrospective study of data from a tumor registry was presented at the American Urological Association Annual Meeting from May 15 – 19.

Barry Stein, MD, of Stratton Veterans Administration Medical Center, Albany, New York, explained that elderly men with prostate cancer are thought to more likely die with rather than of their prostate cancer.

The American Urological Association guidelines panel on detection of prostate cancer does not recommend routine prostate-specific antigen screening in men age 70+ years. The reason supporting this recommendation is that competing comorbidities are thought to be likelier to cause mortality before prostate cancer.

Dr Stein determined the mortality rate from prostate cancer in elderly men. He examined the records of all prostate cancer patients diagnosed at the Stratton Veterans Affairs Medical Center from 2000 through 2009 and identified 568 patients from the tumor registry. Of those, 23 transferred out of the Veterans Administration network, leaving 545 patients with sufficient follow-up for determination of their outcome.

The 545 men were divided into six age categories. The majority of patients were age 60 – 79 years. Determination of their prostate cancer risk stratification was performed using D’Amico criteria. Results showed an increasing risk category directly proportional to rising age. The youngest patients, aged 40 – 49 years, had the highest percentage of low-risk prostate cancer, though the total numbers of men in this group were small.

Patients in the age 60 – 69 year category had the highest percentage of intermediate-risk prostate cancer. The oldest group, whose age ranged from 70 -99 years, had the highest percentage of high-risk prostate cancer. Of patients 70+ years of age, 41.1% had stage >T2b disease, 41.1% had a Gleason grade of 8 – 10, and 73.4% had a prostate-specific antigen value >20. Mortality rates due to prostate cancer were determined.

Dr Stein concluded that in this series of patients, prostate cancer was not innocuous in elderly men. Of patients age 70+ years, a total of 124 of 223 (55.6%) fell into the D’Amico high-risk category. The mortality rate from prostate cancer was as high as that from other causes. The notion that older men die with but not of prostate cancer may lead to a delay in diagnosis.

Work is underway to determine whether this high-risk disease in this population is in part responsible for their high mortality rates. Further studies are needed to substantiate this elevated rate of high-risk disease in men age 70+ years. Outcomes of such studies could lead to a change in the treatment paradigm in this population.