Abstract
Diagnostic and therapeutic strategies of prostate cancer may largely influenced by patients' age at presentation. This study is aimed to evaluate the characteristics, diagnostic and treatment strategies in prostate cancer patients in our centres. A cross-sectional analytic study of prostate cancer data in two main referral cancer centres, Cipto Mangunkusumo General Hospital and Dharmais National Cancer Centre from 1995-2010, was therefore performed. Patients were divided into 2 sub-populations; below 60 years (younger patients) and 75 years old and above (older patients). PSA levels, diagnostic modalities, Gleason score and therapeutic options were analysed for both and compared using bivariate analysis. 152 patients were <60 years and 210 were ≥75 years. There was no statistical difference in mean PSA level (797.9ng/mL vs 345.3 ng/mL, respectively; p>0.05) and diagnosis was made by biopsy in majority of patients in both groups (68.2% and 71.6% in younger and older groups respectively). Most presented with an advanced disease stage (65.1% and 66.0%, respectively) and there was no statistically significant difference in mean Gleason scores f (8.1 vs 7.7; p>0.05). Primary androgen deprivation therapy (PADT) was the main treatment for overall patients (48.0% and 50.7%, respectively). Radiotherapy and radical prostatectomy are the main therapeutic modalities for younger patients with local and locally advanced disease (39.6% and 35.4% respectively), while the majority of older patients with the same disease stage were treated with radiotherapy and PADT (45.8% and 39.0% respectively). Differences observed in treatment modalities were statistically significant (p<0.0003). We conclude that there is no difference in disease clinical aggressiveness of the two groups but significant differences were obseved in therapeutic strategies utilised with younger and older patients.
Highlights
There was no statistical difference in mean prostate-specific antigen (PSA) level (797.9ng/mL vs 345.3 ng/mL, respectively; p>0.05) and diagnosis was made by biopsy in majority of patients in both groups (68.2% and 71.6% in younger and older groups respectively)
Radiotherapy and radical prostatectomy are the main therapeutic modalities for younger patients with local and locally advanced disease (39.6% and 35.4% respectively), while the majority of older patients with the same disease stage were treated with radiotherapy and Primary androgen deprivation therapy (PADT) (45.8% and 39.0% respectively)
It is acknowledged that prostate cancer occurs predominantly in elderly patients, with peak incidence occurring between the ages of 70 and 74 years (Klein et al, 2007)
Summary
It is acknowledged that prostate cancer occurs predominantly in elderly patients, with peak incidence occurring between the ages of 70 and 74 years (Klein et al, 2007). National data documented in the participating two centres in this study, revealed peak incidence of prostate cancer diagnosis is in population between 66-72 years (Umbas ., 2005). This may mainly contributed to the widespread adoption of prostate-specific antigen (PSA) testing, which has led to escalating proportion of men being diagnosed with early stage and low or intermediate grade prostate cancer (Wong et al, 2006; Astigueta et al, 2010; Yang et al, 2010). As the number of diagnosis being made increased in younger population, many issues arise in relation to tumour aggressiveness, diagnostic and therapeutic strategies. Many have questioned the role of primary hormonal treatment in elderly patients with localised or locally advanced disease (Berger et al, 2009; Cooperberg and Konety, 2009; Droz et al, 2010) Despite such findings, there is currently no well-documented data available in stratifying tumour
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