Advancing age within established Gleason score categories and the risk of prostate cancer-specific mortality (PCSM)

作者：Russo Andrea L^*; Chen Ming Hui; Aizer Ayal A; Hattangadi Jona A; D' Amico Anthony V

来源：BJU International, 2012, 110(7): 973-979.

DOI：10.1111/j.1464-410X.2012.11470.x

• prostatic neoplasms
• neoplasm grading
• mortality
• SEER programme
• age-related risk

OBJECTIVE %26lt;br%26gt;To determine if advancing age is a risk factor for high-grade prostate cancer due to occult high-grade disease in elderly men with Gleason score 6 or 7 prostate cancer. We investigated whether advancing age is associated with the risk of prostate cancer-specific mortality (PCSM) within established Gleason score categories adjusting for known predictors of PCSM. %26lt;br%26gt;PATIENTS AND METHODS %26lt;br%26gt;Using data from the Surveillance, Epidemiology and End Results database between 1 January 2004 to 31 December 2007, 166 104 men with non-metastatic prostate cancer were identified and formed the study cohort. %26lt;br%26gt;Within established Gleason score categories, Fine and Gray%26apos;s multivariable competing risk regressions were used to evaluate whether increasing age at diagnosis was significantly associated with an increased risk of PCSM, adjusting for prostate-specific antigen level and T-category at diagnosis and whether treatment was curative or non-curative. %26lt;br%26gt;RESULTS %26lt;br%26gt;After adjusting for treatment and prognostic factors, Gleason score 8-10 and 7 as compared with %26lt;= 6 was associated with an increased risk of PCSM (P %26lt; 0.001). %26lt;br%26gt;Increasing age was associated with an increased risk of PCSM only in Gleason score 6 (adjusted hazard ratio [AHR] 1.06, 95% confidence interval [CI] 1.04-1.08, P %26lt; 0.001) and 7 (AHR 1.02, 95% CI 1.01-1.03, P %26lt; 0.001), but not with Gleason score 8-10 (AHR 0.999, 95% CI 0.995-1.003, P = 0.61). %26lt;br%26gt;These risks were highest in men aged %26gt;70 years having Gleason score 6 (AHR 1.10, 95% CI 1.07-1.13, P %26lt; 0.001) and Gleason score 7 prostate cancer (AHR 1.04, 95% CI 1.02-1.06, P %26lt; 0.001). %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;PCSM increases with advancing age in men with Gleason score 6 and 7 but not 8-10 prostate cancer. %26lt;br%26gt;Techniques to reduce biopsy sampling error in men, particularly those aged %26gt;70 years and healthy with Gleason score 6 and 7 disease deserve further study.

• 出版日期2012-10