Impact of Age on Treatment Patterns and Outcomes in Patients With Non-Metastatic Castration-Resistant Prostate Cancer

To evaluate the impact of age on treatment patterns and outcomes in patients with non-metastatic castration-resistant prostate cancer (nmCRPC).

We conducted a retrospective multicenter analysis of 428 patients with nmCRPC from 25 tertiary centers (2002-2022). Patients were divided into two age groups: < 80 and ≥ 80 years. The outcomes included cancer-specific survival (CSS), overall survival (OS), and progression-free survival (PFS).

Among 428 patients (median follow-up, 32.5 months), performance status (PS) 0 was more frequent in < 80 vs. ≥ 80 years (78% vs. 58%, p < 0.001). Use of first-line androgen receptor signaling inhibitors (ARSIs) was similar (58% vs. 59%, p = 0.83) among all, whereas any-line docetaxel use was less common in patients aged ≥ 80 years (33% vs. 9% for < 80 vs. ≥ 80, p < 0.001). Five-year CSS was 76.5% vs. 63.7% (p = 0.002) and five-year OS 73.8% vs. 59.9% (p = 0.006) for < 80 vs. ≥ 80 years, respectively. Time-to-treatment failure was shorter in patients aged ≥ 80 years (p = 0.04).

Maintaining PS and managing ARSI-related adverse events are essential in older patients with nmCRPC and may preserve their eligibility for chemotherapy and improve their prognosis.