title: The effect of age at diagnosis on prostate cancer mortality: a grade-for-grade and stage-for-stage analysis.
abstract: OBJECTIVE
  To evaluate the effect of advancing age on cancer-specific mortality (CSM) after radical prostatectomy (RP).
  
  
  METHODS
  Overall, 205,551 patients with PCa diagnosed between 1988 and 2009 within the Surveillance Epidemiology and End Results (SEER) database were included in the study. Patients were stratified according to age at diagnosis: ≤ 50, 51-60, 61-70, and ≥ 71 years. The 15-year cumulative incidence CSM rates were computed. Competing-risks regression models were performed to test the effect of age on CSM in the entire cohort, and for each grade (Gleason score 2-4, 5-7, and 8-10) and stage (pT2, pT3a, and pT3b) sub-cohorts.
  
  
  RESULTS
  Advancing age was associated with higher 15-year CSM rates (2.3 vs. 3.4 vs. 4.6 vs. 6.3% for patients aged ≤ 50 vs. 51-60 vs. 61-70 vs. ≥ 71 years, respectively; P < 0.001). In multivariable analyses, age at diagnosis was a significant predictor of CSM. This relationship was also observed in sub-analyses focusing on patients with Gleason score 5-7, and/or pT2 disease (all P ≤ 0.05). Conversely, age failed to reach the independent predictor status in men with Gleason score 2-4, 8-10, pT3a, and/or pT3b disease.
  
  
  CONCLUSIONS
  Advancing age increases the risk of CSM. However, when considering patients affected by more aggressive disease, age was not significantly associated with higher risk of dying from PCa. In high-risk patients, tumor characteristics rather than age should be considered when making treatment decisions.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: giorgio.gandaglia@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
authors.forename: P I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Martiniclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Ruhr-University Bochum, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, NY, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Urology, University of Montreal Health Centre, Montreal, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Perrotte
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
authors.forename: Q-D
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sun
mesh_terms: D000367:Age Factors; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: Age at diagnosis; Cancer-specific survival; Competing-risks; Prostate cancer; Radical prostatectomy