Pathology grade influences competing mortality risks in elderly men with prostate cancer

Area of Science:

• Urology
• Oncology
• Geriatric Medicine

Background:

• Active management of prostate cancer (PC) is recommended for elderly men, particularly those with high-risk disease.
• Limited data exists on PC-specific mortality in men over 70, considering Gleason score (GS) and prostate-specific antigen (PSA) levels.
• This study addresses the lack of descriptive data on PC mortality in elderly men.

Purpose of the Study:

• To evaluate the influence of GS and PSA levels on prostate cancer mortality (PCM) and all-cause mortality.
• To analyze these risks in both localized PC (LPC) and metastatic PC (MPC) in men over 70.
• To provide data for counseling elderly men on PC management options.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database for men diagnosed with PC over 70 (2004-2016).
• Stratified patients into localized (LPC) and metastatic (MPC) groups, by age, GS (<7, 7, >7), and PSA levels (<4, 4-10, 10-20, 20-50, >50 ng/mL).
• Calculated competing risk estimates for PCM and other-cause mortality.

Main Results:

• Of 85,649 men, 85.5% had LPC; 15% died over 4 years median follow-up, one-third from PC.
• Men with GS >7 had >30% PCM in the LPC group and were significantly associated with PCM in the MPC group.
• PCM correlated with PSA levels, reaching up to 50% (LPC) and 70% (MPC) for PSA >50 ng/mL.

Conclusions:

• Elderly men over 70 with LPC and GS >7 or PSA >20 ng/mL have a substantial risk of PC death.
• For MPC, PCM increased significantly with GS, exceeding 50% for GS >7.
• Findings, combined with comorbidity data, can aid in counseling elderly men on PC management.