Abstract: PD47-05
Sources of Funding: none

Introduction

Annually over 10,000 men are diagnosed with prostate cancer (PC) in the Netherlands and almost half are older than 70 years. As the effect of treatment might differ for older patients, we examined the clinical features, applied treatments, and prognosis for older PC patients in the Netherlands.

Methods

All patients diagnosed with PC in 2013 were retrieved from the database of the nationwide population-based Netherlands Cancer Registry. We examined the clinical characteristics, treatment, and 5-year relative survival (as approximation of PC specific survival) of patients aged 0-60, 60-69, 70-79, and ≥80.

Results

Approximately 46% (n=5001) of diagnosed PC patients in 2013 were ≥70 years and 10% (n=1164) ≥80 years. PSA level at diagnosis and Gleason score progressively increased with age. Also, older patients were more often diagnosed with advanced stage of PC (cT4/N+/M+) compared to younger patients; 12% of patients aged <60 years versus 39% of patients aged ≥80 years had an advanced stage. For all disease stages combined, the proportion of patients that underwent curative treatment decreased with increasing age. Within the group of cT2 patients, 70% of patients aged 70-79 years and 16% of patients aged ≥80 years were treated with curative intent compared to 85% of younger patients. The vast majority of cT3 patients received radiotherapy in combination with hormonal therapy, regardless of age. However, in the eldest patients (≥80 years) hormonal monotherapy was applied most frequently (>60%). In the patients with cT4/N+/M+ PC, the use of hormonal therapy as monotherapy increased strongly with increasing age. The 5-year relative survival decreased with increasing age: 92% for the patients aged <70 years, 87% for patients aged 70-80 years, and 68% for patients aged ≥80 years. The 5-year relative survival of low stage PC appeared to be similar for patients aged <70 years versus ≥70, whereas the survival of advanced PC (≥T3) was worse for older patients: 5-year relative survival is 97% versus 91% for the cT3 patients and 53% versus 43% for the cT4/N+/M+, respectively for patients aged <70 years versus ≥70 years.

Conclusions

Elderly men with PC are more often diagnosed with advanced disease, possibly as a result of patients' or doctors' delay. After adjusting for disease stage, older patients have a worse prognosis than younger patients. Further research should elucidate whether elderly PC patients are treated optimally while taking the increased life expectancy and the trade-off between the beneficial effects and adverse events of the treatments into account.

Funding

none