J Urol. 2019 Jan;201(1):98-104. doi: 10.1016/j.juro.2018.08.023.
Age at prostate cancer diagnosis has been positively associated with prostate cancer specific mortality and in men on active surveillance with a higher risk of biopsy grade reclassification to Gleason score 3 + 4 or greater (Grade Group 2 or greater). However, to our knowledge the association between age and biopsy grade reclassification to an aggressive phenotype (Gleason score 4 + 3 or greater [Grade Group 3 or greater]) has not been explored.
From 1995 to 2016 we followed 1,625 men 41 to 81 years old with NCCN® (National Comprehensive Cancer Network®) very low (68%) or low (32%) risk prostate cancer on active surveillance. We determined the rate of biopsy grade reclassification to Grade Group 3 or greater. Competing risk analysis was applied to evaluate the association between age at enrollment and the risk of biopsy grade reclassification. Additionally, in men who underwent radical prostatectomy after biopsy grade reclassification we assessed the rate of radical prostatectomy grade reclassification (ie radical prostatectomy Grade Group greater than biopsy Grade Group).
The 5-year incidence of biopsy grade reclassification to Grade Group 3 or greater was 4%, 7% and 14% in men younger than 60, 60 to 69 and 70 years old or older, respectively (p <0.001). On univariate analysis older age was associated with biopsy grade reclassification to Grade Group 3 or greater (per 10-year increase HR 2.43, p <0.001). On multivariable analysis adjusting for year of diagnosis, race, prostate specific antigen density and cancer volume at diagnosis older age remained associated with biopsy grade reclassification to Grade Group 3 or greater (per 10-year increase HR 2.19, p <0.001). In men who underwent radical prostatectomy after biopsy grade reclassification those who were older had a higher rate of radical prostatectomy grade reclassification (p <0.05).
In men on active surveillance older age at diagnosis was positively associated with biopsy grade reclassification to Grade Group 3 or greater and radical prostatectomy grade reclassification. These observations imply that for many older men, active surveillance as opposed to watchful waiting remains a more appropriate management strategy.
前列腺癌诊断时的年龄与前列腺癌特异性死亡率呈正相关，在接受主动监测的患者中，发生活检分级重新分类为 Gleason 评分 3+4 或更高（Gleason 分组 2 或更高）的风险更高。然而，据我们所知，年龄与活检分级重新分类为侵袭性表型（Gleason 评分 4+3 或更高[Gleason 分组 3 或更高]）之间的关系尚未得到探讨。
1995 年至 2016 年，我们对 1625 名年龄在 41 岁至 81 岁的 NCCN（美国国家综合癌症网络）低危（68%）或中危（32%）前列腺癌患者进行了随访，这些患者正在接受主动监测。我们确定了活检分级重新分类为 Gleason 分组 3 或更高的发生率。采用竞争风险分析评估了入组时年龄与活检分级重新分类风险之间的关系。此外，在活检分级重新分类后接受根治性前列腺切除术的患者中，我们评估了根治性前列腺切除术分级重新分类（即根治性前列腺切除术 Gleason 分组高于活检 Gleason 分组）的发生率。
在年龄小于 60 岁、60 至 69 岁和 70 岁或以上的患者中，5 年内活检分级重新分类为 Gleason 分组 3 或更高的发生率分别为 4%、7%和 14%（p<0.001）。单因素分析显示，年龄越大，活检分级重新分类为 Gleason 分组 3 或更高的风险越高（每增加 10 岁，HR 2.43，p<0.001）。多因素分析调整诊断年份、种族、前列腺特异性抗原密度和诊断时的肿瘤体积后，年龄与活检分级重新分类为 Gleason 分组 3 或更高仍相关（每增加 10 岁，HR 2.19，p<0.001）。在活检分级重新分类后接受根治性前列腺切除术的患者中，年龄较大的患者根治性前列腺切除术分级重新分类的发生率更高（p<0.05）。
在接受主动监测的患者中，诊断时的年龄与活检分级重新分类为 Gleason 分组 3 或更高以及根治性前列腺切除术分级重新分类呈正相关。这些观察结果表明，对于许多老年男性而言，主动监测而非静观其变仍然是更合适的管理策略。
