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Age dependence of modern clinical risk groups for localized prostate cancer — a population-based study

By Minh-Phuong Huynh-Le, Tor Åge Myklebust, Christine H. Feng, Roshan Karunamuni, Tom Børge Johannesen, Anders M. Dale, Ole A Andreassen, Tyler M Seibert

Posted 24 May 2019
bioRxiv DOI: 10.1101/648519 (published DOI: 10.1002/cncr.32702)

Background: Optimal prostate cancer (PCa) screening strategies will focus on men most likely to have potentially-lethal, localized disease. Age-specific incidence rates (ASIRs) for clinical risk groups could guide risk-stratified screening. Objective: Determine ASIRs and proportions of PCa diagnoses in Norway for modern risk-group and Gleason score categories. Design, Setting, and Participants: All men diagnosed with PCa in Norway in 2014-2017 (n=20,356). Outcome Measurements and Statistical Analysis: Patients were assigned to clinical risk groups: low, favorable-intermediate, unfavorable-intermediate, high, regional, and metastatic, using Gleason score and clinical stage. Associations were assessed between age and (1) Gleason score (including Gleason 3+4 and 4+3) and (2) PCa risk group. Risk-group ASIRs were calculated by multiplying the overall Norwegian ASIR by the proportions observed for each category. Results: Older age was significantly associated with higher Gleason score and more advanced disease. For example, among men aged 55-59, 65-69, 75-79, and 85-89 years, the percentage with Gleason 8-10 disease was 16.5%, 23.4%, 37.2%, and 59.9%, respectively (p<0.001); the percentage with at least high-risk disease was 29.3%, 39.1%, 60.4%, and 90.6%, respectively. Corresponding percentages for low-risk PCa were 24.0%, 17.9%, 10.2%, and 4.1% (p<0.001). The respective maximum ASIRs (per 100,000 men) for low-risk, favorable-intermediate-risk, unfavorable-intermediate-risk, high-risk, regional, and metastatic disease were: 157.1, 183.8, 194.8, 408.3, 172.3, and 330.0; incidence for low-risk and favorable-intermediate-risk PCa peaked before age 70, while more advanced categories peaked after 70. At age 75-79 years, the ASIR of high-risk disease was approximately 6 times greater than at 55-59 years. Conclusions: Risk of clinically-significant, localized PCa increases with age. Healthy older men may be among those most likely to benefit from PCa screening.

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