Association of clinical benign prostate hyperplasia with prostate cancer incidence and mortality revisited: a nationwide cohort study of 3 009 258 men

Abstract

Conclusions: The currently used AS criteria performed significantly better for patients aged < 70 years. The authors concluded that the current results should be taken into account when deciding whether to offer active surveillance to patients with low-risk PCa. Editorial Comment The major issue related to an initial surveillance policy is the possibility of losing the window of curability of the disease, and this is directly related to patients' life expectancy according to their comorbidity profile and disease natural history that are very heterogeneous and unpredictable, in part due to the misclassification of patients regarding these variables. Previous studies suggest an association between age and prostate cancer aggressiveness, this study though retrospective and not including patients under active surveillance, highlights that older patients are affected more frequently by more aggressive disease at final pathology compared with their younger counterparts, even when they are affected by very-low-risk disease according to the criteria proposed by van den Bergh et al. and Carter et al.. In this context, mortality should be considered as the main outcome in future confirmatory studies and while older patients are typically encouraged to undergo active surveillance due to virtually shorter life expectancy, better tools predicting life expectancy and disease natural history are warranted.