Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia.
The South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, SA, Australia.
BJU Int. 2018 May;121 Suppl 3:48-54. doi: 10.1111/bju.14228.
To investigate the rate of prostate cancer-specific mortality (PCSM) and disease characteristics in patients diagnosed with localised prostate cancer at age 80-89 years in comparison with men diagnosed at age 70-79 years.
This is a retrospective study of data from the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC). Included were men diagnosed between 2005 and 2014, aged ≥70 years with no evidence of metastatic disease at presentation. Propensity score matching and competing risk Fine and Grey regression were used to assess the chance of treatment (curative vs non-curative) and treatment effect on PCSM.
Of the 1 951 eligible patients, 1 428 (76%) were aged 70-79 years and 460 (24%) were aged 80-89 years at diagnosis, with a median (interquartile range) age of 74 (72-76) and 83 (81-85) years, respectively. The 80-89 years group had higher Gleason scores and Prostate Specific Antigen (PSA) values (all P < 0.001) in comparison with the younger group. The 80-89 years group were less likely to be treated with curative treatment (odds ratio 0.12, 95% confidence interval 0.09-0.16; P < 0.001). The proportion of deaths attributable to prostate cancer was similar in both groups: 73 of 263 deaths (28%) in the 80-89 years group vs 97 of 310 deaths (31%) in the 70-79 years group. The risk of PCSM in individuals treated with curative intent was reduced in both groups.
The proportion of prostate cancer deaths was similar in both groups. These findings support carefully selected individualised management of elderly patients diagnosed with localised prostate cancer.
比较 80-89 岁和 70-79 岁诊断为局限性前列腺癌患者的前列腺癌特异性死亡率（PCSM）和疾病特征。
这是一项对南澳大利亚前列腺癌临床结果协作组（SA-PCCOC）数据的回顾性研究。纳入标准为 2005 年至 2014 年期间诊断、无远处转移证据且年龄≥70 岁的男性。采用倾向评分匹配和竞争风险 Fine 和 Grey 回归评估治疗（根治性与非根治性）的可能性和治疗对 PCSM 的影响。
在 1951 名合格患者中，1428 名（76%）年龄为 70-79 岁，460 名（24%）年龄为 80-89 岁，中位（四分位间距）年龄分别为 74（72-76）和 83（81-85）岁。与年轻组相比，80-89 岁组的 Gleason 评分和前列腺特异性抗原（PSA）值更高（均 P<0.001）。80-89 岁组接受根治性治疗的可能性较低（优势比 0.12，95%置信区间 0.09-0.16；P<0.001）。两组因前列腺癌死亡的比例相似：80-89 岁组 263 例死亡中有 73 例（28%）归因于前列腺癌，70-79 岁组 310 例死亡中有 97 例（31%）归因于前列腺癌。两组接受根治性治疗的个体的 PCSM 风险均降低。
两组的前列腺癌死亡比例相似。这些发现支持对诊断为局限性前列腺癌的老年患者进行仔细选择的个体化管理。
