BERKELEY, CA (UroToday.com) - In this recent article published in the Journal of Urology, we discussed the clinicopathological features and outcomes for men 70 years old or older who were diagnosed with prostate cancer.
This study originated from the Center for Prostate Disease (CPDR) Multicenter National Database Program. The database is a comprehensive collection of data used to learn more about prostate disease – particularly prostate cancer – in order to develop more effective prevention, diagnostic, and treatment strategies. CPDR is a Department of Defense program affiliated with Walter Reed Army Medical Center, the Uniformed Services University of the Health Sciences, the Armed Forces Institute of Pathology, and several other military medical centers across the country. It is also a component of the Henry M. Jackson Foundation for the Advancement of Military Medicine. Between 1989 and 2009, the study sample consisted of 12,081 patient records of men diagnosed with prostate cancer. Of those, 3,650 (30.2%) were 70 years old or older, and 2,561 (21.2%) were African American.
Despite the focus on when or even if to initiate prostate cancer screening, there is a conspicuous lack of consensus on the age at which screening should stop. The main risk factor for prostate cancer is age; therefore, as men get older, the prevalence of this disease will concomitantly rise. The U.S. Census Bureau estimates that 36.3 million Americans are currently older than 65 years old, and this number will increase to 86.7 million by 2050. Several investigators have stressed shifting the focus from age to a greater consideration of disease state and tumor biology because these have a greater affect on outcomes.
Our findings indicate that as men age, clinical parameters consistent with more aggressive disease become more prevalent. It is unknown whether this observation is caused by the natural progression of undiagnosed prostate cancer or if there are adverse biological changes such as those that might occur from hormonal deregulation present with aging. Despite evidence in our study group that indicated disease characteristics worsened with age, time to death was comparable across age quartiles. Our data show that under-grading of prostate cancer is more prevalent with age – with men 70 years old or older having nearly 2-fold higher odds than other age groups. This finding has been supported in several other studies, and the consistency of this finding is of particular interest because men with poorly differentiated disease have a 10-fold greater likelihood of dying of prostate cancer than age-matched controls with well differentiated disease.
The purpose of this study was to characterize the disease in the elderly. The American Cancer Society has very definitive recommendations regarding age limit parameters for screening and suggests that screening should be restricted to men with a life expectancy of at least 10 years. As life expectancy continues to increase, and with recent findings that show men in their 70s are currently living beyond the 10-year life expectancy benchmark, our assessment of age-specific biological potential, natural history, and treatment recommendations for the disease must be fluid. Further work needs to be conducted on this topic – in particular, studies that examine patient age in combination with patient medical comorbidities. Such approaches may help avoid limiting recommendations for treatment to younger men but extend treatment to men 70 years old or older who may be at increased risk of aggressive disease.
Written by:
Stephen A. Brassell, MD, FACS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
