Older Men with Intermediate to High Risk Prostate Cancer-Patterns of Care and Outcomes of Treatment


There is significant controversy on how aggressively to treat older men with prostate cancer. We identified 1082 patients diagnosed with prostate cancer from 1998-2008 with Gleason score ≥ 7 on biopsy or prostatectomy pathology in the South Texas Veteran’s Healthcare System. Prostate specific antigen (PSA) values, pathology, treatment and response to treatment were analyzed. Mean follow up was 4.99 years. Patients > 74 years had significantly higher pretreatment PSA, higher grade disease, and were received hormone therapy more often. Unadjusted hazard ratios for metastasis and cancer related death were 2.15 (95% CI 1.02, 4.52; p = 0.04) and 2.66 (95% CI 1.18, 6; p = 0.02), respectively. However, after controlling for treatment, Gleason score and pre-treatment PSA, there was no significant difference in cancer specific survival (CSS) by age group. In the patients > 74 years, there was also no significant difference in overall survival (OS) or CSS among patients treated with surgery, radiation or hormones after controlling for Gleason score and pre-treatment PSA. Our oldest patients have worse cancer presumably to later diagnosis, but they do just as well as younger patients with any given treatment modality. Most importantly, they have similar cancer specific survival with hormone therapy as they do with radiation or surgery.

Share and Cite:

E. B. Holliday, G. P. Swanson, F. Du and J. W. Basler, "Older Men with Intermediate to High Risk Prostate Cancer-Patterns of Care and Outcomes of Treatment," Journal of Cancer Therapy, Vol. 3 No. 5, 2012, pp. 575-581. doi: 10.4236/jct.2012.35073.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Jemal, R. Siegel, J. Xu, et al., “Cancer Statistics,” CA: A Cancer Journal for Clinicians, Vol. 60, No. 5, 2010, pp. 277-300. doi:10.3322/caac.20073
[2] J. M. Fitzpatrick, “Management of Localized Prostate Cancer in Senior Adults: The Crucial Role of Comorbidity,” BJU International, Vol. 101, Suppl.2, 2008, pp. 16-22. doi:10.1111/j.1464-410X.2007.07487.x
[3] D. Ilic, D. O’Connor, S. Green, et al., “Screening for Prostate Cancer: An Updated Cochrane Systematic Review,” BJU International, Vol. 107, No. 6, 2011, pp. 882-891.doi:10.1111/j.1464-410X.2010.10032.x
[4] US Preventive Services Task Force, “Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement,” Annals of Internal Medicine, Vol. 122, No. 1, 2008, pp. 185-191. doi:10.1542/peds.2007-2210
[5] J. L. Mohler, R. R. Bahnson, B. Boston, et al., “NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer,” Journal of the National Comprehensive Cancer Network, Vol. 10, No. 9, 2010, pp. 162-200.
[6] M. S. Cookson, G. Aus, A. L. Burnett, et al., “Variation in the Definition of Biochemical Recurrence in Patients Treated for Localized Prostate Cancer: The American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel Report and Recommendations for a Standard in the Reporting of Surgical Outcomes,” The Journal of Urology, Vol. 177, No. 2, 2007, pp. 540-545. doi:10.1016/j.juro.2006.10.097
[7] M. Roach, G. Hanks, H. Thames, et al., “Defining Biochemical Failure Following Radiotherapy with or without Hormonal Therapy in Men with Clinically Localized Prostate Cancer: Recommendations of the RTOG-ASTRO Phoenix Consensus Conference,” International Journal of Radiation Oncology, Biology, Physics, Vol. 65, No. 4, 2006, pp. 965-974. doi:10.1016/j.ijrobp.2006.04.029
[8] N. B. Delongchamps, C. Y. Wang, V. Chandan, et al., “Pathological Characteristics of Prostate Cancer in Elderly Men,” The Journal of Urology, Vol. 182, No. 3, 2009, pp. 927-930. doi:10.1016/j.juro.2009.05.018
[9] J. C. Sung, J. N. Kabalin and M. K. Terris, “Prostate Cancer Detection, Characterization, and Clinical Outcomes in Men Aged 70 Years and Older Referred for Transrectal Ultrasound and Prostate Biopsies,” Urology, Vol. 56, No. 2, 2000, pp. 295-301.doi:10.1016/S0090-4295(00)00611-7
[10] K. Lin, R. Lipsitz, T. Miller, et al., “Benefits and Harms of Prostate-Specific Antigen Screening for Prostate Cancer: An Evidence Update for the US Preventive Services Task Force,” Annals of Internal Medicine, Vol. 149, No. 63, 2008, pp. 192-199.
[11] P. C. Albertsen, J. A. Hanley and J. Fine, “20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer,” The Journal of the American Medical, Vol. 293, No. 17, 2005, pp. 2095-2101.doi:10.1001/jama.293.17.2095
[12] C. B. Begg, E. R. Riedel, P. B. Bach,et al., “Variations in Morbidity after Radical Prostatectomy,” The New England Journal of Medicine, Vol. 346, 2002, pp. 1138-1144. doi:10.1056/NEJMsa011788
[13] A. Bill-Axelson, L. Holmberg, F. Filen, et al., “Radical Prostatectomy versus Watchful Waiting in Localized Prostate Cancer: The Scandinavian Prostate Cancer Group-4 Randomized Trial,” Journal of the National Cancer Institute, Vol. 100, No. 16, 2008, pp. 1144-1154. doi:10.1093/jnci/djn255
[14] T. Bubolz, J. H. Wasson, L.-Y. Grace, et al., “Treatments for Prostate Cancer in Older Men: 1984-1997,” Urology, Vol. 58, No. 6, 2001, pp. 977-982. doi:10.1016/S0090-4295(01)01434-0
[15] P. A. Kupelian, L. Potters, D. Khuntia, et al., “Radical Prostatectomy, External Beam Radiotherapy < 72 Gy, External Beam Radiotherapy > or =72 Gy, Permanent Seed Implantation, or Combined Seeds/External Beam Radiotherapy for Stage T1-T2 Prostate Cancer,” International Journal of Radiation Oncology, Biology, Physics, Vol. 58, No. 1, 2004, pp. 25-33. doi:10.1016/S0360-3016(03)00784-3
[16] S. M. Alibhai, M. Leach, G. A. Tomlinson, et al., “Is There an Optimal Comorbidity Index for Prostate Cancer?” Cancer, Vol. 112, No. 5, 2008, pp. 1043-1050. doi:10.1002/cncr.23269
[17] K. L. Schwartz, S. M. Alibhai, G. Tomlinson, et al., “Continued Undertreatment of Older Men with Localized Prostate Cancer,” Urology, Vol. 62, No. 5, 2003, pp. 860-865. doi:10.1016/S0090-4295(03)00690-3

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.