Brigham and Women's Hospital, Department of Radiation Oncology, 75 Francis St, ASB1-L2, Boston, MA 02215, USA.
BJU Int. 2012 Oct;110(7):973-9. doi: 10.1111/j.1464-410X.2012.11470.x.
Study Type - Prognosis (case series) Level of Evidence 4. What's known on the subject? and What does the study add? There is limited data that suggests that men aged >70 years have a higher proportion of Gleason 8-10 prostate cancer than men aged <70 years, as well as a higher risk of PSA recurrence, distant metastases, and disease-specific death on univariate analysis. The present study shows that older as compared with younger men with Gleason score 6 and 7 prostate cancer have an increased risk of prostate cancer-specific mortality. This may be due to the presence of occult high-grade disease and suggests further diagnostic studies, e.g. multiparametric MRI, may be indicated in these men to reduce biopsy sampling error.
To determine if advancing age is a risk factor for high-grade prostate cancer due to occult high-grade disease in elderly men with Gleason score 6 or 7 prostate cancer. We investigated whether advancing age is associated with the risk of prostate cancer-specific mortality (PCSM) within established Gleason score categories adjusting for known predictors of PCSM.
Using data from the Surveillance, Epidemiology and End Results database between 1 January 2004 to 31 December 2007, 166 104 men with non-metastatic prostate cancer were identified and formed the study cohort. • Within established Gleason score categories, Fine and Gray's multivariable competing risk regressions were used to evaluate whether increasing age at diagnosis was significantly associated with an increased risk of PCSM, adjusting for prostate-specific antigen level and T-category at diagnosis and whether treatment was curative or non-curative.
After adjusting for treatment and prognostic factors, Gleason score 8-10 and 7 as compared with ≤6 was associated with an increased risk of PCSM (P < 0.001). • Increasing age was associated with an increased risk of PCSM only in Gleason score 6 (adjusted hazard ratio [AHR] 1.06, 95% confidence interval [CI] 1.04-1.08, P < 0.001) and 7 (AHR 1.02, 95% CI 1.01-1.03, P < 0.001), but not with Gleason score 8-10 (AHR 0.999, 95% CI 0.995-1.003, P= 0.61). • These risks were highest in men aged >70 years having Gleason score 6 (AHR 1.10, 95% CI 1.07-1.13, P < 0.001) and Gleason score 7 prostate cancer (AHR 1.04, 95% CI 1.02-1.06, P < 0.001).
PCSM increases with advancing age in men with Gleason score 6 and 7 but not 8-10 prostate cancer. • Techniques to reduce biopsy sampling error in men, particularly those aged >70 years and healthy with Gleason score 6 and 7 disease deserve further study.
确定在 Gleason 评分 6 或 7 的前列腺癌老年男性中，年龄增长是否是由于隐匿性高级别疾病导致高级别前列腺癌的危险因素。我们研究了在已知前列腺癌特异性死亡率（PCSM）预测因素的基础上，年龄增长是否与既定 Gleason 评分范围内的 PCSM 风险相关。
利用 2004 年 1 月 1 日至 2007 年 12 月 31 日期间监测、流行病学和最终结果数据库的数据，确定了 166104 名非转移性前列腺癌患者作为研究队列。在既定 Gleason 评分范围内，采用 Fine 和 Gray 的多变量竞争风险回归，评估诊断时年龄增长是否与 PCSM 风险增加显著相关，同时调整前列腺特异性抗原水平和诊断时 T 分期，并调整治疗是否为根治性或非根治性。
调整治疗和预后因素后，与 Gleason 评分 8-10 和 7 相比，Gleason 评分≤6 与 PCSM 风险增加相关（P<0.001）。年龄增长仅与 Gleason 评分 6（调整后的危险比 [AHR]1.06，95%置信区间 [CI]1.04-1.08，P<0.001）和 7（AHR 1.02，95%CI 1.01-1.03，P<0.001）与 PCSM 风险增加相关，但与 Gleason 评分 8-10 无关（AHR 0.999，95%CI 0.995-1.003，P=0.61）。在年龄>70 岁的男性中，Gleason 评分 6（AHR 1.10，95%CI 1.07-1.13，P<0.001）和 Gleason 评分 7 前列腺癌（AHR 1.04，95%CI 1.02-1.06，P<0.001）的风险最高。
在 Gleason 评分 6 和 7 的男性中，PCSM 随年龄增长而增加，但在 Gleason 评分 8-10 的男性中则不然。需要进一步研究降低 Gleason 评分 6 和 7 疾病、特别是年龄>70 岁且健康男性中活检采样误差的技术。
