Relationship of age to histologic grade in prostate cancer

Abstract

We studied 4,968 cases of prostatic carcinoma to determine if there is a relationship between tumor grade and patient age at diagnosis. Cases were stratified into arbitrary age groups and classified as either better differentiated (Grades I and II) or worse differentiated (Grades III and IV). The 4,596 graded cases were distributed by stage as follows: Local 3,451 (75%), Regional 509 (11%), and Distant 636 (14%). When patients in all stages were considered together, the percentage of men with better differentiated tumors dropped from 77.8% of patients under 60 to 67.5% of patients 80 or older (P less than 0.00001). This trend for older patients to have more poorly differentiated tumors was also seen in patients with localized disease (P less than 0.0005). The fact that occult, biologically inactive prostate cancer is common in older men has led some to extrapolate that clinically apparent disease follows a more benign course in the elderly. Our findings suggest that, on the contrary, elderly men with clinically apparent disease have worse differentiated tumors than their younger counterparts.

Gleason score, age and screening: Modeling dedifferentiation in prostate cancer

“…10,11 Several authors studied dedifferentiation by comparing differentiation in metastases and primary tumors 20,21 and concluded that there is a trend toward histological dedifferentiation when prostate carcinoma metastasizes to regional lymph nodes. It could be argued however, that these observations are the consequence of a higher potential for metastasis of poorly differentiated tumor cells, rather than dedifferentiation.…”

“…We investigated whether our data show a relation between Gleason score, clinical T-stage (cT-stage) and age at diagnosis as noted by others. 10,11 We used the findings to discriminate between 2 MISCAN simulation models that do not allow (Model I) or do allow (Model II) dedifferentiation in the screendetectable phase. A significantly better fit to observed data of Model II is a strong indication of dedifferentiation that could be prevented by early detection and treatment.…”

Race and the histologic grade of prostate cancer

“…First, we examined the data for conformity with previously described race, stage, age, and grade differentials of prostate cancer [17][18][19]. Specifically, for race (black vs. white), stage (localized, regional, distant), age tertiles (< 65 years, 65-74 years, and Ն 75 years), and grade (well, moderate, poorly, and undifferentiated) we analyzed the following relationships: 1) race-stage, 2) race-age at diagnosis, 3) stagegrade, and 4) age at diagnosis-grade.…”

The association between patient age and prostate cancer stage and grade at diagnosis

“…A second explanation is that tumour biology may change with age, such that older patients present with more advanced or aggressive tumours [11]. Although age/stage relationships have been described for several other malignancies [7,24,25], the strongest relationships have been reported for tumours that are amenable to screening (i.e.…”

“…Four previous studies have examined changes in prostate cancer stage with increasing age [6][7][8][9]; whereas two found a change toward more early-and distant-stage disease in the oldest group ( ≥ 75 years) [7,9], two others found no age/stage relationship [6,8]. Two studies have examined the age/grade relationship in a broadly sampled group of men with prostate cancer [10,11]; one reported an increase in grade with increasing age [11], whereas the other found no such relationship [10].…”