Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA 94143-1695, USA.
J Clin Oncol. 2011 Jan 10;29(2):235-41. doi: 10.1200/JCO.2010.30.2075. Epub 2010 Dec 6.
Older men are more likely to be diagnosed with high-risk prostate cancer and to have lower overall survival. As a result, age often plays a role in treatment choice. However, the relationships among age, disease risk, and prostate cancer-specific survival have not been well established.
We studied men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with complete risk, treatment, and follow-up information. High-risk patients were identified by using the validated Cancer of the Prostate Risk Assessment (CAPRA) score. Competing risks regression was used to identify the independent impact of age on cancer-specific survival. We also analyzed the effect of local treatment on survival among older men with high-risk disease.
In all, 26% of men age ≥ 75 years presented with high-risk disease (CAPRA score 6 to 10). Treatment varied markedly with age across risk strata; older men were more likely to receive androgen deprivation monotherapy. Controlling for treatment modality alone, or for treatment and risk, age did not independently predict cancer-specific survival. Furthermore, controlling for age, comorbidity, and risk, older men with high-risk tumors receiving local therapy had a 46% reduction in mortality compared with those treated conservatively.
Older patients are more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy. Indeed, underuse of potentially curative local therapy among older men with high-risk disease may in part explain observed differences in cancer-specific survival across age strata. These findings support making decisions regarding treatment on the basis of disease risk and life expectancy rather than on chronologic age.
年龄较大的男性更有可能被诊断为高危前列腺癌，且整体存活率较低。因此，年龄通常会影响治疗选择。然而，年龄、疾病风险和前列腺癌特异性生存之间的关系尚未得到充分证实。
我们研究了癌症前列腺战略泌尿研究 Endeavor（CaPSURE）数据库中具有完整风险、治疗和随访信息的男性。高危患者通过使用经过验证的前列腺癌风险评估（CAPRA）评分来确定。竞争风险回归用于确定年龄对前列腺癌特异性生存的独立影响。我们还分析了局部治疗对患有高危疾病的老年男性生存的影响。
共有 26%年龄≥75 岁的男性患有高危疾病（CAPRA 评分 6 至 10 分）。治疗方案因年龄和风险而异；年龄较大的男性更有可能接受雄激素剥夺单药治疗。仅控制治疗方式或治疗和风险因素，年龄并不能独立预测前列腺癌特异性生存。此外，控制年龄、合并症和风险后，接受局部治疗的患有高危肿瘤的老年男性死亡率降低了 46%，与保守治疗的患者相比。
老年患者在诊断时更有可能患有高危前列腺癌，且更不可能接受局部治疗。事实上，高危疾病老年男性局部治疗的潜在应用不足，可能部分解释了各年龄组之间前列腺癌特异性生存的差异。这些发现支持根据疾病风险和预期寿命而不是年龄来制定治疗决策。
