AUA 2017: Elderly Prostate Cancer Patients Have A Worse Prognosis Than Younger Patients: A Population-based Study In The Netherlands

Boston, MA ( Annually over 10,000 men are diagnosed with prostate cancer (PC) in the Netherlands and almost half are older than 70 years. As the effect of treatment might differ for older patients, Dr. Vernooij presented a study on the clinical features, applied treatments, and prognosis for older PC patients in the Netherlands.

All patients diagnosed with PC between 2005-2015 were retrieved from the database of the nationwide population-based Netherlands Cancer Registry. Overall 98,017 patients were included. The authors examined the clinical characteristics, treatment, and 5-year relative survival (as approximation of PC specific survival) of patients aged 0-60, 60-69, 70-79, and ≥80.

Median age was 69 (IQR: 12) and 47% were older than 70 years. PSA level at diagnosis and Gleason score progressively increased with age. Median PSA of 9 ng/ml (IQR: 10) was demonstrated in patients younger than 70 and a median PSA of 14 ng/ml (IQR: 31) was seen for older than 70 patients. 38% of the older and 22% of the younger patients had a Gleason score higher than 7.

Older patients were more often diagnosed with advanced stage of PC (cT4/N+/M+) compared to younger patients. High risk disease was present in 15% and 23% of the younger and older patients, respectively. When looking at the treatment these patients received, radical prostatectomy was performed in 32% and 7% of the younger and older patients, respectively. Hormonal therapy was administered to 9% and 28% of the younger and older patients, respectively. The 5 and 10 -year relative survival decreased with increasing age: 92% and 82% and 86% and 70% for the younger and older patients at 5 and 10 years, respectively.

In summary, elderly men with PC are more often diagnosed with advanced disease. Additionally they are less actively treated when compared to younger patients. After adjusting for disease stage, Gleason score, PSA at diagnosis and comorbidities, patients older than 70 fare worse than patients younger than 70. Dr. Vernooij concluded his presentation by recommending consideration of more aggressive therapy for older patients.

Presented By: Robin W.M. Vernooij, Utrecht, Netherlands

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
Twitter: @Goldberghanan

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA