Older Men with Intermediate to High Risk Prostate Cancer-Patterns of Care and Outcomes of Treatment

Abstract

There is significant controversy on how aggressively to treat older men with prostate cancer. We identified 1082 patients diagnosed with prostate cancer from 1998-2008 with Gleason score ≥ 7 on biopsy or prostatectomy pathology in the South Texas Veteran’s Healthcare System. Prostate specific antigen (PSA) values, pathology, treatment and response to treatment were analyzed. Mean follow up was 4.99 years. Patients > 74 years had significantly higher pretreatment PSA, higher grade disease, and were received hormone therapy more often. Unadjusted hazard ratios for metastasis and cancer related death were 2.15 (95% CI 1.02, 4.52; p = 0.04) and 2.66 (95% CI 1.18, 6; p = 0.02), respectively. However, after controlling for treatment, Gleason score and pre-treatment PSA, there was no significant difference in cancer specific survival (CSS) by age group. In the patients > 74 years, there was also no significant difference in overall survival (OS) or CSS among patients treated with surgery, radiation or hormones after controlling for Gleason score and pre-treatment PSA. Our oldest patients have worse cancer presumably to later diagnosis, but they do just as well as younger patients with any given treatment modality. Most importantly, they have similar cancer specific survival with hormone therapy as they do with radiation or surgery.