Background Old age at prostate cancer diagnosis has been associated with poor prognosis in several studies. We aimed to investigate the association between age at diagnosis and prognosis, and if it is independent of tumor characteristics, primary treatment, year of diagnosis, mode of detection and comorbidity. Patients and methods We conducted a nation-wide cohort study including 121 392 Swedish men aged 55-95 years in Prostate Cancer data Base Sweden 3.0 diagnosed with prostate cancer in 1998-2012 and followed for prostate cancer death through 2014. Data were available on age, stage, grade, prostate-specific antigen (PSA)-level, mode of detection, comorbidity, educational level and primary treatment. We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results With increasing age at diagnosis, men had more comorbidity, fewer PSA-detected cancers, more advanced cancers and were less often treated with curative intent. Among men with high-risk or regionally metastatic disease, the proportion of men with unknown M stage was higher among old men versus young men. During a follow-up of 751 000 person-years, 23 649 men died of prostate cancer. In multivariable Cox-regression analyses stratified by treatment, old age at diagnosis was associated with poorer prognosis among men treated with deferred treatment (HRage 85+ versus 60-64: 7.19; 95% CI: 5.61-9.20), androgen deprivation therapy (HRage 85+ versus 60-64: 1.72; 95% CI: 1.61-1.84) or radical prostatectomy (HRage 75+ versus 60-64: 2.20; 95% CI: 1.01-4.77), but not radiotherapy (HRage 75+ versus 60-64: 1.08; 95% CI: 0.76-1.53). Conclusion Our findings argue against a strong inherent effect of age on risk of prostate cancer death, but indicate that in current clinical practice, old men with prostate cancer receive insufficient diagnostic workup and subsequent curative treatment.

中文翻译：

---

诊断年龄，前列腺癌的治疗和预后：基于人群的队列研究。

背景技术在一些研究中，前列腺癌诊断的高龄与不良预后有关。我们的目的是调查年龄在诊断和预后之间的关联，以及是否与肿瘤特征，主要治疗，诊断年份，检测方式和合并症无关。患者和方法我们进行了一项全国性队列研究，在1998-2012年在瑞典前列腺癌数据库瑞典3.0中诊断为55岁至95岁的121 392名瑞典男性，之后被诊断为前列腺癌，直到2014年死亡。 ，阶段，等级，前列腺特异性抗原（PSA）级别，检测方式，合并症，教育程度和主要治疗方法。我们使用Cox回归来计算危险比（HRs）和95％置信区间（CIs）。结果随着诊断年龄的增长，男性合并症较多，PSA检出的癌症较少，晚期癌症较多，较少接受治愈性治疗。在高危或局部转移性疾病的男性中，M期未知的男性比例在老年男性中高于年轻男性。在751 000人年的随访中，有23 649名男性死于前列腺癌。在按治疗分层的多变量Cox回归分析中，接受延迟治疗（HRage 85+ vs 60-64：7.19； 95％CI：5.61-9.20）和雄激素剥夺疗法（HRage）的男性，诊断时的高龄与预后较差有关。 85+ vs 60-64：1.72; 95％CI：1.61-1.84）或根治性前列腺切除术（HRage 75+ vs 60-64：2.20; 95％CI：1.01-4.77），但放射疗法不适用（HRage 75+ vs 60-64 64：1.08； 95％CI：0.76-1.53​​）。