Age-related patterns in prostate cancer: epidemiology, pathology, treatment, and survival

Contemporary, systematic comparisons of prostate cancer (PCa) across the entire age spectrum regarding incidence, pathology, treatment, and long-term outcomes remain lacking.

Patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database to assess age-related differences in pathological features, treatment patterns, and cancer-specific survival (CSS), with additional analyses accounting for competing risks from other-cause mortality.

Older age was associated with lower stage risk but higher PSA, ISUP grade, and overall disease risk (20-55 as reference; 56-65, OR = 1.29, 95% CI, 1.27-1.32, p < 0.001; 66-75, OR = 1.67, 95% CI, 1.64-1.71, p < 0.001; 76-85, OR = 3.10, 95% CI, 3.03-3.18, p < 0.001). In nonmetastatic patients, the likelihood of receiving definitive treatment and choosing radical prostatectomy decreases with age. Overall, CSS worsened with age; however, the 56-65 years group showed no significant difference compared with the 20-55 years reference group (HR = 1.00, 95% CI, 0.95-1.06, p = 0.872), whereas the older age groups presented progressively poorer CSS (66-75, HR = 1.16, 95% CI, 1.10-1.23, p < 0.001; 76-85, HR = 1.72, 95% CI, 1.62-1.82, p < 0.001). After accounting for other-cause mortality using a competing-risk model, similar patterns were observed.

PCa is increasingly diagnosed in older men, with higher age associated with earlier-stage presentation but more adverse pathology, less frequent radical prostatectomy, and risk-dependent survival effects across age groups.