Age dependence of modern clinical risk groups for localized prostate cancer—A population‐based study

Abstract

Background Optimal prostate cancer (PCa) screening strategies will focus on men likely to have potentially lethal disease. Age‐specific incidence rates (ASIRs) by modern clinical risk groups could inform risk stratification efforts for screening. Methods This cross‐sectional population study identified all men diagnosed with PCa in Norway from 2014 to 2017 (n = 20,356). Age, Gleason score (primary plus secondary), and clinical stage were extracted. Patients were assigned to clinical risk groups: low, favorable intermediate, unfavorable intermediate, high, regional, and metastatic. Chi‐square tests analyzed the independence of Gleason scores and modern PCa risk groups with age. ASIRs for each risk group were calculated as the product of Norwegian ASIRs for all PCa and the proportions observed for each risk category. Results Older age was significantly associated with a higher Gleason score and more advanced disease. The percentages of men with Gleason 8 to 10 disease among men aged 55 to 59, 65 to 69, 75 to 79, and 85 to 89 years were 16.5%, 23.4%, 37.2%, and 59.9%, respectively (P < .001); the percentages of men in the same age groups with at least high‐risk disease were 29.3%, 39.1%, 60.4%, and 90.6%, respectively (P < .001). The maximum ASIRs (per 100,000 men) for low‐risk, favorable intermediate‐risk, unfavorable intermediate‐risk, high‐risk, regional, and metastatic disease were 157.1 for those aged 65 to 69 years, 183.8 for those aged 65 to 69 years, 194.8 for those aged 70 to 74 years, 408.3 for those aged 75 to 79 years, 159.7 for those aged ≥85 years, and 314.0 for those aged ≥85 years, respectively. At the ages of 75 to 79 years, the ASIR of high‐risk disease was approximately 6 times greater than the ASIR at 55 to 59 years. Conclusions The risk of clinically significant localized PCa increases with age. Healthy older men may benefit from screening.

A genetic risk score to personalize prostate cancer screening, applied to population data.

“…Determination of age of aggressive disease onset is thus highly relevant. Data from the CAP study shown here confirm prior findings of increasing risk of aggressive prostate cancer as men age [21][22][23][24] . However, the proportion of new prostate cancer diagnoses classified as aggressive in CAP is higher than some older studies that were limited to men with low PSA and normal digital rectal exam [25][26][27] , while modern population studies show similar or higher proportions with aggressive disease 21 .…”

Additional SNPs improve the performance of a polygenic hazard score for prostate cancer

“…Clinically meaningful risk stratification is illustrated by the estimated cumulative incidence curves in Figure 1. This effect is particularly pronounced for clinically significant disease because of the increased proportion of clinically significant cases observed at older ages 2,20,22 .…”

Common genetic and clinical risk factors: Association with fatal prostate cancer in the Cohort of Swedish Men

“…Age is a critical consideration in prostate cancer decision-making 29 , especially as medical co-morbidities and competing risk of death increase with aging 30 . At the same time, prostate cancer incidence rises exponentially with age and is typically more aggressive when diagnosed at an older age 31,32 .…”