Login to Access Video or Poster Abstract: MP43-18
Sources of Funding: None

Introduction

Compared to younger men with prostate cancer (PCa), older men with the disease are more likely to present at an advanced stage, and even when adjusting for stage and grade, to die of the disease. Despite this phenomenon, older men, often with competing comorbidities, are more likely to elect active surveillance (AS) rather than primary definitive treatment. We sought to investigate whether advanced age at PCa diagnosis is a risk factor for grade reclassification (GR) while on AS. Additionally, for men ultimately going on to have secondary radical prostatectomy (RP) after initial AS, we sought to investigate whether advanced age at RP is a risk factor for adverse post-operative outcomes, including pathologic Gleason score (GS) upgrading, adverse RP pathology, and biochemical recurrence (BCR)._x000D_

Methods

Between 1995 and 2016, 1554 men aged 41-81 years (median 66 years) with NCCN very low (70%) and low (30%) risk PCa on AS were followed using an institutional database. We queried this database to determine rates of GR (biopsy GS≥3+4), as well as pathologic GS upgrading, adverse RP pathology (≥pT3a or pathologic GS≥4+3), and BCR in patients going on to RP. A competing risk analysis was used to evaluate the association between age and time to GR and BCR. Likewise, a multivariable logistic regression model was used to determine whether age at RP was a significant risk factor for pathologic GS upgrading and adverse RP pathology. Odds (OR) and hazard (HR) ratios were calculated for 10-year age increases.

Results

Of the 1554 men in our AS cohort, 331 (21%) had GR and 295 (19% of all men) went on to have RP. Of those who underwent RP, 155 (53%) had pathologic GS upgrading, 89 (30%) had adverse RP pathology, and 18 men (6%) developed BCR after a median of 3 years. Age at diagnosis of PCa was a significant risk factor for GR (HR 1.4; 95%CI 1.2-1.7; p=0.0003). Of those going on to RP, age at RP was a significant risk factor for pathologic GS upgrading (OR 2.2; 95%CI 1.3-3.7; p=0.005), adverse RP pathology (OR 2.6; 95%CI 1.4-4.9; p=0.004), and BCR (HR 3.6; 95%CI 1.1-11.2; p=0.03).

Conclusions

For men on AS, age at PCa diagnosis is a significant risk factor for GR, and age at RP after being on AS is a significant risk factor for pathologic GS upgrading, adverse RP pathology, and BCR. These observations have significant implications for monitoring older men on AS.

Funding

None