Prostate Cancer in Younger and Older Patients: Do We Treat Them Differently?

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 patientsin 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 thereforeperformed. Patients were divided into 2 sub-populations; below 60 years (younger patients) and 75 years old andabove (older patients). PSA levels, diagnostic modalities, Gleason score and therapeutic options were analysed forboth and compared using bivariate analysis. 152 patients were <60 years and 210 were ≥75 years. There was nostatistical difference in mean PSA level (797.9ng/mL vs 345.3 ng/mL, respectively; p>0.05) and diagnosis was madeby 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 statisticallysignificant 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 radicalprostatectomy 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 treatedwith radiotherapy and PADT (45.8% and 39.0% respectively). Differences observed in treatment modalitieswere statistically significant (p<0.0003). We conclude that there is no difference in disease clinical aggressivenessof the two groups but significant differences were obseved in therapeutic strategies utilised with younger andolder patients.