Does age influence the behaviour of localized prostate cancer?

Is Age an Independent Factor for Prostate Cancer? A Paired Analysis

INTRODUCTION

Prostate cancer is the most prevalent malignant neoplasia among men worldwide. Several prognostic factors, including Gleason's score, the measurement of serum prostate-specific antigen (PSA) and the evaluation of the percentage of fragments affected by cancer on prostate biopsy, have already been established. Age alone, however, has yet to be studied as a prognostic factor independently from other known factors. The aim of the present study was to compare the characteristics and the evolution of prostate cancer in different age groups using a paired analysis for patients with equivalent known prognostic factors. In addition, we aimed to determine the true impact of age on the prognosis of prostate cancer.

MATERIAL AND METHODS

The data from 2,283 patients subjected to radical retropubic prostatectomy between 1998 and 2009 were reviewed. The patients were divided into three age groups: < 55 years old, between 56 and 65 and > 65 years old. Each patient was matched to another patient in the other groups who had the same PSA range (< 4.0, between 4.0 and 10.0 and > 10), Gleason score on the surgical specimen and prognostic range of positive fragments in the prostate biopsy (< 33%, between 34 and 50% and > 50%). After pairing, each group consisted of 215 patients, who were compared using the biochemical recurrence of the disease (PSA > 0.2), the interval for biochemical relapse, extra-capsular invasion and invasion of the seminal vesicles or the lymph nodes. RESULTS. No significant difference was observed between the groups regarding the frequency of relapses, interval of relapse, extra-capsular invasion and invasion of the seminal vesicles or lymph nodes.

DISCUSSION

None of the studied factors were affected by the age of the patients. Therefore, patients of different ages had tumors with similar characteristics and behaviors.

CONCLUSION

When assessed separately, without the effects of the main prognostic factors, age does not appear to be an independent prognostic factor for prostate cancer.

Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy

OBJECTIVE

This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP).

MATERIALS AND METHODS

We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study.

RESULTS

The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p=0.004), capsular invasion (CI) (p=0.001), age (p=0.014), and tumor size (p=0.006). However, only CI was found to be significant in multivariate analysis (p=0.001).

CONCLUSION

Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.

High-throughput transcriptomic analysis nominates proteasomal genes as age-specific biomarkers and therapeutic targets in prostate cancer

BACKGROUND

Although prostate cancer (PCa) is hypothesized to differ in nature between younger versus older patients, the underlying molecular distinctions are poorly understood. We hypothesized that high-throughput transcriptomic analysis would elucidate biological differences in PCas arising in younger versus older men, and would nominate potential age-specific biomarkers and therapeutic targets.

METHODS

The high-density Affymetrix GeneChip platform, encompassing >1 million genomic loci, was utilized to assess gene expression in 1090 radical prostatectomy samples from patients with long-term follow-up. We identified genes associated with metastatic progression by 10 years post-treatment in younger (age<65) versus older (age⩾65) patients, and ranked these genes by their prognostic value. We performed Gene Set Enrichment Analysis (GSEA) to nominate biological concepts that demonstrated age-specific effects, and validated a target by treating with a clinically available drug in three PCa cell lines derived from younger men.

RESULTS

Over 80% of the top 1000 prognostic genes in younger and older men were specific to that age group. GSEA nominated the proteasome pathway as the most differentially prognostic in younger versus older patients. High expression of proteasomal genes conferred worse prognosis in younger but not older men on univariate and multivariate analysis. Bortezomib, a Food and Drug Administration approved proteasome inhibitor, decreased proliferation in three PCa cell lines derived from younger patients.

CONCLUSIONS

Our data show significant global differences in prognostic genes between older versus younger men. We nominate proteasomeal gene expression as an age-specific biomarker and potential therapeutic target specifically in younger men. Limitations of our study include clinical differences between cohorts, and increased comorbidities and lower survival in older patients. These intriguing findings suggest that current models of PCa biology do not adequately represent genetic heterogeneity of PCa related to age, and future clinical trials would benefit from stratification based on age.

Clinical outcomes in a contemporary series of "young" patients with castration-resistant prostate cancer who were 60 years and younger

BACKGROUND

The prognosis of younger patients with prostate cancer is unclear, and the very few studies assessing those with metastatic castration-resistant prostate cancer (mCRPC) have mainly involved patients treated with older therapies. The aim of this observational study was to evaluate the clinical outcomes of a contemporary series of docetaxel-treated patients with mCRPC who were 60 years and younger.

PATIENTS AND METHODS

We retrospectively identified 134 patients who were 60 years and younger who were treated with docetaxel in 25 Italian hospitals and recorded their predocetaxel history of prostate cancer, their characteristics at the start of chemotherapy, and their postdocetaxel treatment history and outcomes.

RESULTS

Most of the 134 consecutive patients with mCRPC received the standard 3-week docetaxel schedule; median progression-free survival (PFS) was 7 months, and 90 patients underwent further therapies after progression. The median overall survival (OS) from the start of docetaxel treatment was 21 months, but OS was significantly prolonged by the postprogression treatments, particularly those based on the new agents such as cabazitaxel, abiraterone acetate, or enzalutamide. OS was significantly shorter in the patients with a shorter interval between the diagnosis of prostate cancer and the start of docetaxel treatment; those who received hormonal treatment for a shorter period; those with shorter prostate-specific antigen doubling times; and those with lower hemoglobin levels, a worse performance status, and higher lactate dehydrogenase levels before starting treatment with docetaxel.

CONCLUSIONS

The findings of this first study of clinical outcomes in a contemporary series of younger patients with mCRPC showed that their survival is similar to that expected in unselected patients with mCRPC who were of any age.

Controversial predictors of biochemical recurrence after radical prostatectomy: a study from a Latin American (Brazilian) institution

PURPOSE

To analyze controversial clinicopathologic predictors of biochemical recurrence after surgery: age, race, tumor extent on surgical specimen, tumor extent on needle biopsy, Gleason score 3 + 4 vs 4 + 3, and amount of extent of extraprostatic extension and positive surgical margins.

MATERIALS AND METHODS

The needle biopsies and the correspondent surgical specimens were analyzed from 400 patients. Time to recurrence was analyzed with the Kaplan-Meier curves and risk of shorter time to recurrence using Cox univariate and multivariate analysis.

RESULTS

Except for age, race, maximum percentage of cancer per core, and number of cores with cancer, all other variables studied were significantly predictive of time to biochemical recurrence using the Kaplan-Meier curves. In univariate analysis, except for focal extraprostatic extension, age, race, focal positive surgical margins, and maximum extent and percentage of cancer per core, all other variables were significantly predictive of shorter time to recurrence. On multivariate analysis, diffuse positive surgical margins and preoperative PSA were independent predictors.

CONCLUSIONS

Young patients and non-whites were not significantly associated with time to biochemical recurrence. The time consuming tumor extent evaluation in surgical specimens seems not to add additional information to other well established predictive findings. The higher predictive value of Gleason score 4 + 3 = 7 vs 3 + 4 = 7 discloses the importance of grade 4 as the predominant pattern. Extent and not simply presence or absent of extraprostatic extension should be informed. Most tumor extent evaluations on needle biopsies are predictive of time to biochemical recurrence, however, maximum percentage of cancer in all cores was the strongest predictor.

Impact of Age at Diagnosis on Outcomes in Men with Castrate-Resistant Prostate Cancer (CRPC)

Background: The association between age and outcomes in men with castrate resistant prostate cancer (CRPC) is not well understood.

Objective: We aimed to evaluate CRPC patients to determine if their age at initial diagnosis impacted their cancer specific outcomes.

Design, Setting, and Participants: A retrospective chart review was conducted on 333 consecutive CRPC patients treated at the Princess Margaret Hospital (PMH) between 1995 and 2005. Patients were divided into 4 age categories, (A) <55, (B) 55-64, (C) 65-74 (reference), and (D) ≥ 75 years (yrs).

Outcome Measurements and Statistical Analysis: Primary endpoints included impact of age at diagnosis on overall survival (OS) and on prostate cancer specific survival. Secondary endpoints were time from diagnosis to development of CRPC, time from CRPC to death, and time from diagnosis to bone metastases.

Results and Limitations: The median OS from diagnosis to death was: Group A 5.5 yrs (95% CI 3.0-7.5); Group B 6.7 yrs (95% CI 5.9-8.4); Group C 7.8 yrs (95% CI 6.6-9.3); and Group D 4.3 years (95% CI 2.9-5.0). The hazard ratio (HR) for death in Group D was 2.58 (95% CI 1.58-4.21, p=0.0002); and in Group A was 1.49 (95% CI 0.90-2.46, p=0.13). The duration of hormone sensitivity in Group D was less and predictive of OS, as was Gleason Score ≥8 and Stage 4 disease at diagnosis.

Conclusions: Age at initial diagnosis appears to impact on outcome of patients who subsequently develop CRPC with a bimodal distribution of risk, with the shortest survivals in the ≥75 and <55 groups.

Older age predicts decreased metastasis and prostate cancer-specific death for men treated with radiation therapy: meta-analysis of radiation therapy oncology group trials

PURPOSE

The impact of age on prostate cancer (PCa) outcome has been controversial; therefore, we analyzed the effect of age on overall survival (OS), distant metastasis, prostate cancer-specific death (PCSD), and nonprostate cancer death (NPCD) on patients with locally advanced PCa.

METHODS AND MATERIALS

Patients who participated in four Radiation Therapy Oncology Group (RTOG) phase III trials, 8531, 8610, 9202, and 9413, were studied. Cox proportional hazards regression was used for OS analysis, and cumulative events analysis with Fine and Gray's regression was used for analyses of metastasis, PCSD, and NPCD.

RESULTS

Median follow-up of 4,128 patients with median age of 70 (range, 43-88 years) was 7.3 years. Most patients had high-risk disease: cT3 to cT4 (54%) and Gleason scores (GS) of 7 (45%) and 8 to 10 (27%). Older age (≤70 vs. >70 years) predicted for decreased OS (10-year rate, 55% vs. 41%, respectively; p<0.0001) and increased NPCD (10-year rate, 28% vs. 46%, respectively; p<0.0001) but decreased metastasis (10-year rate, 27% vs. 20%, respectively; p<0.0001) and PCSD (10-year rate, 18% vs. 14%, respectively; p<0.0001). To account for competing risks, outcomes were analyzed in 2-year intervals, and age-dependent differences in metastasis and PCSD persisted, even in the earliest time periods. When adjusted for other covariates, an age of >70 years remained associated with decreased OS (hazard ratio [HR], 1.56 [95% confidence interval [CI], 1.43-1.70] p<0.0001) but with decreased metastasis (HR, 0.72 [95% CI, 0.63-0.83] p<0.0001) and PCSD (HR, 0.78 [95% CI, 0.66-0.92] p<0.0001). Finally, the impact of the duration of androgen deprivation therapy as a function of age was evaluated.

CONCLUSIONS

These data support less aggressive PCa in older men, independent of other clinical features. While the biological underpinning of this finding remains unknown, stratification by age in future trials appears to be warranted.

Survival and prognostic factors of patients with clinically localized prostate cancer

OBJECTIVE

To assess survival rates and clinical (pretreatment) prognostic factors in patients with clinically localized adenocarcinoma of the prostate.

METHODS

Hospital cohort including 258 patients registered in the National Cancer Institute, in the city of Rio de Janeiro, southeastern Brazil, from 1990 to 1999. Five- and ten-year survival functions were estimated using the Kaplan-Meier estimator from the histological diagnosis (initial time of follow-up) to death due to prostate cancer (events). Prognostic factors were assessed using hazard ratios (HR) with confidence intervals of 95%, following the Cox's proportional hazards model. The assumption of proportionality of risks was tested using Schoenfeld residuals and the impact of outliers in the model fitness was analyzed using martingale and score residuals.

RESULTS

Of 258 patients studied, 46 died during follow-up. The overall five-year and ten-year survival rates were 88% and 71%, respectively. A Gleason score higher than 6, PSA levels higher than 40 ng/mL, B2 stage, and white skin color were independent markers of poor prognosis.

CONCLUSIONS

Gleason score, digital rectal examination and PSA levels have great predictive power and must be used in pretreatment risk stratification of patients with localized prostate cancer.

Prognostic markers in cancer: the evolution of evidence from single studies to meta-analysis, and beyond

In oncology, prognostic markers are clinical measures used to help elicit an individual patient's risk of a future outcome, such as recurrence of disease after primary treatment. They thus facilitate individual treatment choice and aid in patient counselling. Evidence-based results regarding prognostic markers are therefore very important to both clinicians and their patients. However, there is increasing awareness that prognostic marker studies have been neglected in the drive to improve medical research. Large protocol-driven, prospective studies are the ideal, with appropriate statistical analysis and clear, unbiased reporting of the methods used and the results obtained. Unfortunately, published prognostic studies rarely meet such standards, and systematic reviews and meta-analyses are often only able to draw attention to the paucity of good-quality evidence. We discuss how better-quality prognostic marker evidence can evolve over time from initial exploratory studies, to large protocol-driven primary studies, and then to meta-analysis or even beyond, to large prospectively planned pooled analyses and to the initiation of tumour banks. We highlight articles that facilitate each stage of this process, and that promote current guidelines aimed at improving the design, analysis, and reporting of prognostic marker research. We also outline why collaborative, multi-centre, and multi-disciplinary teams should be an essential part of future studies.

Determinants of change in prostate-specific antigen over time and its association with recurrence after external beam radiation therapy for prostate cancer in five large cohorts

PURPOSE

To assess the relationship between prognostic factors, postradiation prostate-specific antigen (PSA) dynamics, and clinical failure after prostate cancer radiation therapy using contemporary statistical models.

METHODS AND MATERIALS

Data from 4,247 patients with 40,324 PSA measurements treated with external beam radiation monotherapy in five cohorts were analyzed. Temporal change of PSA after treatment completion was described by a specially developed linear mixed model that included standard prognostic factors. These factors, along with predicted PSA evolution, were incorporated into a Cox model to establish their predictive value for the risk of clinical recurrence over time.

RESULTS

Consistent relationships were found across cohorts. The initial PSA decline after radiation therapy was associated with baseline PSA and T-stage (p < 0.001). The long-term PSA rise was associated with baseline PSA, T-stage, and Gleason score (p < 0.001). The risk of clinical recurrence increased with current level (p < 0.001) and current slope of PSA (p < 0.001). In a pooled analysis, higher doses of radiation were associated with a lower long-term PSA rise (p < 0.001) but not with the risk of recurrence after adjusting for PSA trajectory (p = 0.63). Conversely, after adjusting for other factors, increased age at diagnosis was not associated with long-term PSA rise (p = 0.85) but was directly associated with decreased risk of recurrence (p < 0.001).

CONCLUSIONS

We conclude that a linear mixed model can be reliably used to construct typical patient PSA profiles after prostate cancer radiation therapy. Pretreatment factors along with PSA evolution and the associated risk of recurrence provide an efficient and quantitative way to assess the impact of risk factors on disease progression.

Prognostic factors in prostate cancer

In the nineteenth century the main goal of medicine was predictive: diagnose the disease and achieve a satisfying prognosis of the patient's chances. Today the effort has shifted to cure the disease. Since the twentieth century, the word prognosis has also been used in nonmedical contexts, for example in corporate finance or elections. The most accurate form of prognosis is achieved statistically. Based on different prognostic factors it should be possible to tell patients how they are expected to do after prostate cancer has been diagnosed and how different treatments may change this outcome. A prognosis is a prediction. The word prognosis comes from the Greek word (see text) and means foreknowing. In the nineteenth century this was the main goal of medicine: diagnose the disease and achieve a satisfying prognosis of the patient's chances. Today the effort has shifted towards seeking a cure. Prognostic factors in (prostate) cancer are defined as "variables that can account for some of the heterogeneity associated with the expected course and outcome of a disease". Bailey defined prognosis as "a reasoned forecast concerning the course, pattern, progression, duration, and end of the disease. Prognostic factors are not only essential to understand the natural history and the course of the disease, but also to predict possible different outcomes of different treatments or perhaps no treatment at all. This is extremely important in a disease like prostate cancer where there is clear evidence that a substantial number of cases discovered by prostate-specific antigen (PSA) testing are unlikely ever to become clinically significant, not to mention mortal. Furthermore, prognostic factors are of paramount importance for correct interpretation of clinical trials and for the construction of future trials. Finally, according to WHO national screening committee criteria for implementing a national screening programme, widely accepted prognostic factors must be defined before assessing screening.

Is preoperative serum prostate-specific antigen level significantly related to clinical recurrence after radical retropubic prostatectomy for localized prostate cancer?

OBJECTIVE

To evaluate the influence of preoperative serum prostate-specific antigen (PSA) level and other clinicopathological variables on the probability of biochemical failure and clinical recurrence after radical prostatectomy (RP) for localized prostate cancer.

PATIENTS AND METHODS

The study was a retrospective survival analysis in 211 patients undergoing retropubic RP for clinically localized prostate cancer in the period 1988-2000. Survival was estimated using the Kaplan-Meier method; survival endpoints were biochemical failure, defined as a PSA level of > or = 0.5 ng/mL or clinical recurrence consisting of palpable tumours in the prostatic fossa or distant metastases. In 58 patients with biochemical failure after surgery, we assessed the impact of the doubling time of serum PSA level (PSADT) on the risk of developing skeletal metastases or local recurrence.

RESULTS

The median (range) observation period was 66 (9-160) months. Biochemical failure occurred in 92 patients (44%) of whom 39 (42%) had local recurrence or skeletal metastases. There was a highly significant association (P < 0.001) between clinical T stage, histological grade, capsular penetration, surgical margin status, seminal vesicle invasion, preoperative serum PSA level and the probability of biochemical failure-free survival. By contrast there was no statistically significant association between preoperative serum PSA level, clinical T stage, surgical margin status, and clinical recurrence. There was a significant relationship between age (P = 0.021), histological grade (P = 0.025), capsular penetration (P = 0.018), seminal vesicle invasion (P = 0014), and clinical recurrence. Cox regression analysis showed that only histological grade and seminal vesicle invasion were independent predictors of clinical recurrence. In a subgroup of 58 patients with a rising serum PSA level after RP, a PSADT of < or = 12.8 months conferred a significantly higher risk (P = 0.015) of developing skeletal metastases than a PSADT of >12.8 months.

CONCLUSION

In the present patients undergoing RP the preoperative serum PSA level was not associated with the clinical outcome, whereas it was significantly related to biochemical failure rate. The probability of skeletal metastases was significantly associated with the PSADT after biochemical failure.

Analysis of impact of age and race on biochemical control after radiotherapy in different prostate cancer settings

OBJECTIVES

To provide a single-institution analysis of the impact of age and race on biochemical control after radiotherapy (RT) administered in different prostate cancer scenarios. Age and race are among the most controversial prognostic factors in determining outcome after RT. Proper understanding of these prognostic factors can assist in both treatment decision-making and the general understanding of the natural history of prostate cancer.

METHODS

The records of 527 consecutive nonmetastatic patients undergoing RT at a single institution and for whom demographic, disease, treatment, and follow-up information were available were reviewed. The cohort was divided into two categories: locally advanced/localized (458 patients) and postprostatectomy (69 patients). Biochemical failure-free survival (BFFS) curves were compared within each group to determine the influence of age and race on biochemical control.

RESULTS

BFFS curves for the entire study population did not reveal any statistically significant difference when separated by age (younger than 60 years versus 60 to 69 years versus 70 years or older; 4-year BFFS 75% versus 70% versus 72%, respectively; P = 0.773) or by race (African American versus white; 4-year BFFS 74% versus 70%, respectively; P = 0.469). Additionally, no statistically significant differences were observed as a function of stage or age within either category (intact prostate or postprostatectomy).

CONCLUSIONS

Age and race did not, in our study, independently influence biochemical control after RT for nonmetastatic prostate cancer. On the basis of the results of this study, age and race should not be used as independent factors in treatment decision-making and in patient counseling concerning prostate cancer.

Analysis of influence of age on acute and chronic radiotherapy toxicity in treatment of prostate cancer

OBJECTIVES

To provide a single-institution analysis of the influence of age on acute and late genitourinary (GU) and gastrointestinal (GI) toxicity after radiotherapy (RT) administered in different prostate cancer scenarios. Improved understanding of the influence of age on toxicity outcome after RT for prostate cancer can assist in treatment decision-making.

METHODS

The records of 527 consecutive nonmetastatic patients receiving RT at a single institution and for whom demographic, disease, treatment, and follow-up information were available were reviewed. The cohort was divided into four major categories as a function of age: younger than 60 years, 60 to 69 years, 70 to 74 years, and 75 years and older. The toxicity rates in each of these categories were tabulated according to the Radiation Therapy Oncology Group toxicity scales and compared using the chi-square test. Additionally, an ordered logit regression analysis was performed for each of these categories using all major patient, disease, and treatment factors.

RESULTS

The toxicity rates were not significantly different as a function of age for either acute GU (P = 0.10) or acute GI (P = 0.19) toxicity or for either late GU (P = 0.22) or late GI (P = 0.09) toxicity. The ordered logit regression analysis showed that age was not a factor that correlated with toxicity in any setting (acute GU, P = 0.44; acute GI, P = 0.55; late GU, P = 0.65; late GI, P = 0.14).

CONCLUSIONS

Patient age did not independently influence GI or GU toxicity after RT for nonmetastatic prostate cancer and should not be used as an independent factor in treatment decision-making or in patient counseling with regard to GI and GU toxicity outcomes after RT.

The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer

The management of localized prostate cancer is based on stage, grade, PSA, and subjective assessment of comorbidity and life expectancy. Over the last 15 y, stage migration and the improved use of Gleason sum, PSA and TNM staging have led to many treatment options for patients with newly diagnosed localized prostate cancer. At the same time, advances in treatment techniques have helped decrease the long-term complications of surgery and radiotherapy. However, the importance of age and comorbidity, in survival outcomes and treatment decision-making has been largely overlooked. Currently, stage, grade, and PSA are the only quantifiable variables consistently used in research and treatment decision-making. Comorbidity and life expectancy have remained largely subjective variables. Increasing longevity and a rapidly aging population have made age and comorbidity increasingly important factors in clinical research and treatment decision-making. This article reviews the importance of age and comorbidity on treatment decisions and survival outcomes in prostate cancer, as well as their use as objectively quantifiable variables. Examples from the general oncology literature are given. The overview also examines validated comorbidity indices and advocates the use of the Charlson Comorbidity Index (CCI) in research outcomes and treatment decision-making in prostate cancer. Several clinical vignettes are provided to demonstrate the potential clinical utility of the CCI as applied to prostate cancer.

Contemporary pathology of prostate cancer

In less than 20 years since the introduction of serum PSA and the spring-loaded 18-gauge prostatic biopsy needle, pathologists have adjusted to the limited tissue requirements of narrow needle specimens to apply criteria for diagnosis and grading of prostate cancer, borrowing from lessons learned from radical prostatectomies. Substantial gains have been made during this period in the understanding of precancerous lesions, mimics of malignancy, the criteria for minimal cancer, variants of cancer, and treatment-induced changes. The light microscopic findings remain the criterion standard for diagnosis against which all new techniques should be measured. Numerous findings have proven to be of value, including simple quantitation of histopathologic features, cancer volume, perineural invasion, and others.

Reporting of prognostic markers: current problems and development of guidelines for evidence-based practice in the future

Prognostic markers help to stratify patients for treatment by identifying patients with different risks of outcome (e.g. recurrence of disease), and are important tools in the management of cancer and many other diseases. Systematic review and meta-analytical approaches to identifying the most valuable prognostic markers are needed because (sometimes conflicting) evidence relating to markers is often published across a number of studies. To investigate the practicality of this approach, an empirical investigation of a systematic review of tumour markers for neuroblastoma was performed; 260 studies of prognostic markers were identified, which considered 130 different markers. The reporting of these studies was often inadequate, in terms of both statistical analysis and presentation, and there was considerable heterogeneity for many important clinical/statistical factors. These problems restricted both the extraction of data and the meta-analysis of results from the primary studies, limiting feasibility of the evidence-based approach.Guidelines for reporting the results of primary prognostic marker studies in cancer, and other diseases, are given in order to facilitate both the interpretation of individual studies and the undertaking of systematic reviews, meta-analysis and, ultimately, evidence-based practice. General availability of full individual patient data is a necessary step forward and would overcome the majority of problems encountered, including poorly reported summary statistics and variability in cutoff level, outcome assessed and adjustment factors used. It would also limit the problem of reporting bias, although publication bias will remain a concern until studies are prospectively registered. Such changes in practice would help important evidence-based reviews to be conducted in order to establish the most appropriate prognostic markers for clinical use, which should ultimately improve patient care.

Advanced age at diagnosis is an independent predictor of time to death from prostate carcinoma for patients undergoing external beam radiation therapy for clinically localized prostate carcinoma

BACKGROUND

Whether age at diagnosis is predictive of time to prostate carcinoma specific death after external beam radiation therapy (RT) for patients who are diagnosed with clinically localized prostate carcinoma during the prostate specific antigen (PSA) era has not been investigated previously.

METHODS

A multivariate Cox regression analysis was used to evaluate the ability of pretreatment risk group and age at diagnosis to predict time to all causes of death and time to death from prostate carcinoma for 381 patients who underwent RT for clinically localized prostate carcinoma.

RESULTS

Age at diagnosis, as a continuous variable (P(continuous) = 0.04), and risk group (P(categorical) = 0.02) were independent predictors of time to death from prostate carcinoma, whereas only age at diagnosis (P(continuous) = 0.01) was a predictor of time to all causes of death. When analyzed as a categorical variable, beginning at age 73 years, age at diagnosis was an independent predictor (P(categorical) < 0.04) of time to death from prostate carcinoma. Upon further analysis, this finding was limited to high-risk patients. For example, age > or = 75 years at diagnosis predicted for a shorter median time to death from prostate carcinoma (6.3 years vs. 9.7 years; P = 0.002) in high-risk patients.

CONCLUSIONS

Patients with clinically localized, high-risk prostate carcinoma who were diagnosed at age > or = 73 years and were treated with RT had a worse prognosis compared with patients who were diagnosed age < 73 years, raising the possibility that a more aggressive prostate carcinoma biology may develop during andropause.