Figure - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Demographic information for entire cohort.
Source publication
It is not clear to what extent the age of diagnosis and the attained age impact on cancer mortality rates in men with newly diagnosed prostate cancer. We estimated annual prostate cancer mortality rates and 20-year survival rates according to the age of diagnosis, race, grade and time since diagnosis using data from the Surveillance, Epidemiology a...
Contexts in source publication
Context 1
... study included 116,796 men diagnosed with prostate cancer between 1992 and 1997 ( Table 1). Most patients self-reported as white (81.9%), followed by African American (12.5%) and other ethnicities (American Indian/Alaskan native, Asian; 5.4%). ...Context 2
... survival experience of the patients is summarized in Table 1. We present the crude number of deaths from prostate cancer, the annual prostate cancer-specific and all-cause mortality rates and the 10-and 20-year actuarial risks of prostate cancer death. ...Context 3
... probability of death from prostate cancer was 18% for white men and was 24% for African American men. The crude probability of death from prostate cancer increased with age of diagnosis; of the men diagnosed before the age of 60, 15.4% died of prostate cancer, of the men diagnosed between age 60 and 70, 16.9% died of prostate cancer and of the men who were diagnosed after age 70, 21.4% died of prostate cancer (Table 1). ...Context 4
... crude probability of death from prostate cancer increased with age of diagnosis; of the men diagnosed before the age of 60, 15.4% died of prostate cancer, of the men diagnosed between age 60 and 70, 16.9% died of prostate cancer and of the men who were diagnosed after age 70, 21.4% died of prostate cancer (Table 1). ...Context 5
... distributions of time to death are presented by age of diagnosis ( Figure S5) and by Gleason score ( Figure S6). For patient subgroups with high mortality rates, the majority of deaths occurred in the first ten years (Table 1). For patient sub-groups with lower mortality rates, the majority of the deaths occurred after ten years. ...Context 6
... contrast, for men with high-grade cancers, the mortality rate declined with time since diagnosis (Figure 3) and the annual number of deaths from prostate cancer peaked early on (years one to three post-diagnosis) (Figure 4). Among those with high-grade cancers, 79.2% of prostate cancer deaths occurred within the first 10 years (Table 1). ...Citations
... Given the observed OS differences for 1L abiraterone versus enzalutamide in mCRPC studies using French and Taiwanese national datasets, it is valuable to examine these survival differences in a US national dataset, such as Medicare, which is more broadly representative of the population than the US VHA and US Flatiron EMR datasets. Medicare is the primary insurer for men aged ≥65 years in the US and, as the majority (~88%) of the deaths from PC occur in this age group, with a median age at death of 79 years, it is important to assess survival differences within this population [22,23]. ...
Background
There are no large head-to-head phase 3 clinical trials comparing overall survival (OS) for abiraterone and enzalutamide. This study used Medicare claims data to compare OS in patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) who initiated abiraterone or enzalutamide.
Methods
This retrospective analysis of the Medicare database (2009–2020) included adult men with ≥1 claim for prostate cancer, metastatic diagnosis, and no prior chemotherapy or novel hormone therapy who initiated first-line (1L) abiraterone or enzalutamide in the index period (September 10, 2014 to May 31, 2017). Cox proportional-hazards models with inverse probability treatment-weighting (IPTW) were used to compare OS between abiraterone- and enzalutamide-treated patients, adjusting for baseline characteristics. Subgroup analyses by baseline characteristics were also conducted.
Results
Overall, 5506 patients who received 1L abiraterone (n = 2911) or enzalutamide (n = 2595) were included. Median follow-up was comparable in both cohorts (abiraterone, 19.1 months; enzalutamide, 20.3 months). IPTW-adjusted median OS (95% CI) was 20.6 months (19.7‒21.4) for abiraterone and 22.5 months (21.2‒23.8) for enzalutamide, with an IPTW-adjusted hazard ratio (95% CI) of 1.10 (1.04–1.16). Median OS was significantly shorter for abiraterone versus enzalutamide in patients ≥75 years old; White patients; patients with baseline diabetes, cardiovascular disease, both diabetes and cardiovascular disease, and renal disease; and across all socioeconomic strata.
Conclusions
In the Medicare chemotherapy-naïve mCRPC population, 1L abiraterone was associated with worse OS versus enzalutamide in the overall population and among subgroups with older age and comorbidities, supporting findings from previous real-world studies and demonstrating a disparity in outcomes.
... Age has been associated with survival in many cancer types. [38][39][40][41][42][43][44] A recent systematic review of pan-cancer prognostic clinicopathological factors associated with survival outcomes found that advanced patient age (135 studies) and higher pathological stage (133 studies) were common features associated with death from cancer, including LUAD. 45 Previous studies have shown that aging and cancer are characterized by a series of partially overlapping "hallmarks" including genomic instability, epigenetic alterations, and chronic inflammation. ...
Background:
The understanding of the factors causing decreased overall survival (OS) in older patients compared to younger patients in lung adenocarcinoma (LUAD) remains.
Methods:
Gene expression profiles of LUAD were obtained from publicly available databases by Kaplan-Meier analysis was performed to determine whether age was associated with patient OS. The immune cell composition in the tumor microenvironment (TME) was evaluated using CIBERSORT. The fraction of stromal and immune cells in tumor samples were also using assessed using multiple tools including ESTIMATE, EPIC, and TIMER. Differentially expressed genes (DEGs) from the RNA-Seq data that were associated with age and immune cell composition were identified using the R package DEGseq. A 22-gene signature composed of DEGs associated with age and immune cell composition that predicted OS were constructed using Least Absolute Shrinkage and Selection Operator (LASSO).
Results:
In The Cancer Genome Atlas (TCGA)-LUAD dataset, we found that younger patients (≤70) had a significant better OS compared to older patients (>70). In addition, older patients had significantly higher expression of immune checkpoint proteins including inhibitory T cell receptors and their ligands. Moreover, analyses using multiple bioinformatics tools showed increased immune infiltration, including CD4+ T cells, in older patients compared to younger patients. We identified a panel of genes differentially expressed between patients >70 years compared to those ≤70 years, as well as between patients with high or low immune scores and selected 84 common genes to construct a prognostic gene signature. A risk score calculated based on 22 genes selected by LASSO predicted 1, 3, and 5-year OS, with an area under the curve (AUC) of 0.72, 0.72, 0.69, receptively, in TCGA-LUAD dataset and an independent validation dataset available from the European Genome-phenome Archive (EGA).
Conclusion:
Our results demonstrate that age contributes to OS of LUAD patients atleast in part through its association with immune infiltration in the TME.
... 18 In addition, an analysis of the SEER database showed that patients who were diagnosed with prostate cancer at age .70 years were more likely to die of their disease than those diagnosed at age ,70 years (21% vs 17%, respectively). 19 A separate analysis of the SEER database showed that patients whose prostate cancer was diagnosed at age $75 years were more likely to have advanced disease and had a higher risk of death from prostate cancer despite greater death rates from competing causes than those diagnosed before age 75 years. 20 Another cohort study in Sweden showed similar results, but also showed that older patients may not receive sufficient diagnostic workup and curative treatment, thus confounding the interpretation of the results. ...
The NCCN Guidelines for Prostate Cancer Early Detection provide recommendations for individuals with a prostate who opt to participate in an early detection program after receiving the appropriate counseling on the pros and cons. These NCCN Guidelines Insights provide a summary of recent updates to the NCCN Guidelines with regard to the testing protocol, use of multiparametric MRI, and management of negative biopsy results to optimize the detection of clinically significant prostate cancer and minimize the detection of indolent disease.
... Although early-stage low-grade prostate cancer can be cured with surgery or radiation therapy, most patients have progressed to CSPC by the time they are admitted to the hospital. ADT therapy can promote tumor dormancy, prolong the survival of patients, and improve the quality of life, but it can rarely cure prostate cancer, and most tumors will recur [110,111]. Tumor resistance to ADT is cumulative: with the change of lineage, some tumor cells will eventually lose AR expression and develop into small cell carcinoma; this type of tumor is called neuroendocrine prostate cancer (NEPC), and this type of cancer cells express neuroendocrine markers, mostly induced by treatment, and a small part is primary, and does not respond to ARSI et al. [112]. Developing new treatments for this type of cancer is an urgent problem for basic research. ...
All aspects of prostate cancer evolution are closely related to androgen levels and the status of the androgen receptor (AR). Almost all treatments target androgen metabolism pathways and AR, from castration-sensitive prostate cancer (CSPC) to castration-resistant prostate cancer (CRPC). Alterations in androgen metabolism and its response are one of the main reasons for prostate cancer drug resistance. In this review, we will introduce androgen metabolism, including how the androgen was synthesized, consumed, and responded to in healthy people and prostate cancer patients, and discuss how these alterations in androgen metabolism contribute to the resistance to anti-androgen therapy.
Objective:
Multiparametric magnetic resonance imaging (mpMRI) -Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort.
Materials and methods:
Between 2015 -2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx.
Results:
379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were < 75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients < 75 years (9.54 vs. 7.8, p < 0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients < 75 years (45% vs. 29%, p < 0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients < 75 years (63% vs. 43%, p < 0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients < 75 years (13% vs. 8%, p = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 -2.31, p < 0.001).
Conclusion:
After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort.
Introduction:
Sarcopenia is a common skeletal muscle disorder in older people. Here we explore the prevalence of sarcopenia and its impact on men with prostate cancer.
Materials and methods:
We searched PubMed, Embase, and Web of Science databases for relevant studies with an explicit definition of sarcopenia in men with prostate cancer which were published between years 2000 and 2022. Prevalence of sarcopenia and its association with time to biochemical recurrence (BCR), progression-free survival (PFS), non-cancer mortality, overall survival (OS), and treatment-related complications in men with prostate cancer were explored. The summary prevalence, hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated.
Results:
A total of 24 studies comprising 3,616 patients with early and advanced prostate cancer were included. The prevalence of sarcopenia and sarcopenic obesity was 43.8% (95% CI 19.2%-68.5%) and 24.0% (95% CI 5.0%-43.1%), respectively. Sarcopenia was not associated with a shorter time to BCR (HR 0.89, 95% CI 0.64-1.23, p = 0.48), a shorter PFS (HR 1.20, 95% CI 0.73-1.97, p = 0.48), or a shorter OS (HR 1.29, 95% CI 0.90-1.85, p = 0.16). In contrast, sarcopenia was significantly associated with a higher non-cancer mortality (HR 1.85, 95% CI 1.23-2.80, p = 0.003). In four out of five studies eligible for assessment, sarcopenia was not associated with an increased risk of treatment-related complications.
Discussion:
Sarcopenia increases the risk of death from other causes in men with prostate cancer. Patients with prostate cancer should be assessed and managed for sarcopenia in everyday clinical practice.
Rationale, aims, and objectives:
The prevalence of patients hospitalized with comorbid prostate cancer (PC) and heart failure (HF) has been steadily increasing. Both diseases share a set of common risk factors, with the most prominent being age. This study aimed to examine the outcomes and costs for patients with comorbid PC and HF, stratified by age.
Methods:
We analyzed 41,340 hospitalization events of patients with PC using the US National Inpatient Sample from 2015 to 2018. Associations of HF with in-hospital mortality, length of stay (LOS), and hospital costs per hospitalization were measured using multivariable logistic regression, negative binomial regression, and generalized linear regression with log-link and gamma distribution, respectively, controlling for covariates. Subgroup analyses were performed for age groups <65 and ≥65.
Results:
Visits of comorbid HF patients made up 2.3% (n = 952) of the PC study sample. Compared with PC patients without HF, those with HF had higher in-hospital mortality rates (odds ratio = 1.33, 95% confidence interval [CI] = 0.96-1.84, p = 0.085), longer hospital stays (incidence rate ratio = 1.32, 95% CI = 1.21-1.44, p < 0.001), and higher hospital costs (cost ratio = 1.17, 95% CI = 1.07-1.27, p = 0.001), controlling for covariates. On average, this amounted to a higher in-hospital mortality rate of 2.10%, an increased LOS of 1.73 days, and higher hospital costs of $2110 per patient. While in-hospital mortality did not differ significantly in patients aged <65 (p = 0.900), patients aged ≥65 had a 41% increased risk of in-hospital mortality compared with those without HF (p = 0.047).
Conclusions:
In comparison to those without HF, PC patients with comorbid HF showed higher rates of in-hospital mortality, LOS, and hospital costs, with mortality showing a significant difference exclusively in the ≥65 population. Effective management of older patients with PC is needed to improve outcomes and decrease costs.
