What causes prostate cancer in older men

Is Prostate Cancer More Aggressive In Men Over 75?

Men who are diagnosed with prostate cancer at age 75 or later are more likely to die from their cancer than younger men.

That was the result of a study by the University of Rochester. The data bring a breath of fresh air to the precautionary discussion.

Over half of prostate cancer deaths were over 75

Up until now, it was assumed that prostate cancer would grow slowly, especially in very old men, and that patients would eventually die for other reasons.

Researcher around Dr. Emil Scosyrev from the University of Rochester in the US state of New York have now shown in a study: Of all the patients who died in the study because of their prostate cancer, more than half were older than 75 years.

In men of this age group, however, only a good quarter of all tumors were diagnosed (Cancer 2011, online October 17).

Data from 460,000 Americans evaluated

The aim of the study was to investigate how often metastases were already present in the various age groups when prostate cancer was diagnosed and whether there was a connection between the age of the patient and prostate cancer-specific mortality.

For this purpose, the data of over 460,000 Americans were evaluated, in whom prostate cancer was diagnosed between 1998 and 2007.

Numbers increased with age

The number of all newly diagnosed prostate carcinomas increased with age and reached a maximum in the 70-year-olds. After that, the frequency fell again. However, this was not the case when looking at the cases in which metastases had already formed (stage M1).

The older the patients were at the time of diagnosis, the more often they had a Gleason score between 8 and 10, that is, the more often the tumor had already metastasized.

Under 75-year-olds: only with three percent metastases

In the group of those under 75 years of age, metastases were found in only 3 percent at the time of diagnosis.

In the case of 75 to 79 year olds this was already the case for 5 percent, for 80 to 84 year olds 8 percent, in the group of 85 to 89 year olds it was 13 percent and for seniors from 90 years of age even 17 percent.

30 percent among those over 90

Correspondingly, the cumulative incidence of deaths from prostate cancer increased with age, although most of the elderly patients naturally died of other causes.

The prostate cancer-specific death rate in patients younger than 75 years was 3 to 4 percent within five years; in the 75 to 79 year olds it was 7 percent (other causes of death in this age group: 21 percent), in the 80 to 84 year olds it was 13 percent (other causes of death 32 percent), in the 85 bis For 89-year-olds it was 20 percent (other causes of death 43 percent) and for those over 90 it was 30 percent (other causes 55 percent).

More than every second cancer patient who died from it was over 75 years old

Only a good quarter of the patients diagnosed with prostate cancer were 75 years of age or older (26 percent). In this age group, however, almost half of the patients (48 percent) had advanced cancer (M1).

And in the group of cancer patients who died of their prostate cancer, seniors aged 75 and over were overrepresented with a share of 53 percent.

Prostate cancer may grow more aggressively in the elderly

The authors' conclusion: One reason for the age-dependent differences in the initial diagnosis and the higher risk of mortality in the elderly could be that prostate cancer may grow more aggressively in older men than previously assumed.

However, it could also play a role that men over the age of 75 participate less frequently in early detection examinations. In addition, if the PSA values ​​are elevated, the very old men could no longer have biopsies as often as the younger ones.

The results of this study are remarkable, especially against the background of the discussion on prostate cancer screening. The data speak for the preventive benefit of regular screening, even for particularly old men.