Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study.

Background: Geriatric oncology guidelines state that fit older men with prostate cancer should receive curative treatment. In a population-based study, we investigated associations between age and non-receipt of curative treatment in men with localised prostate cancer, and the effect of clinical variables on this in different age groups.

Methods: Clinically localised prostate cancers (T1-T2N0M0) diagnosed from 2002 to 2008 among men aged ≥ 40 years, with hospital in-patient episode(s) within 1 year post-diagnosis, were included (n=5456). Clinical and socio-demographic variables were obtained from cancer registrations. Comorbidity was determined from hospital episode data. Logistic regression was used to investigate associations between age and non-receipt of treatment, adjusting for confounders; the outcome was non-receipt of curative treatment (radical prostatectomy or radiotherapy).

Results: The percentage who did not receive curative treatment was 9.2%, 14.3%, 48.2% and 91.7% for men aged 40-59, 60-69, 70-79 and 80+ years, respectively. After adjusting for clinical and socio-demographic factors, age remained the main determinant of treatment non-receipt. Men aged 70-79 had a significant five-fold increased risk of not having curative treatment compared with men aged 60-69 (odds ratio (OR)=5.5; 95% confidence interval 4.7, 6.5). In age-stratified analyses, clinical factors had a higher weight for men aged 60-69 than in other age strata. Over time, non-receipt of curative treatment increased among men aged 40-59 and decreased among men aged 70-79.

Conclusion: Age remains the dominant factor in determining non-receipt of curative treatment. There have been some changes in clinical practice over time, but whether these will impact on prostate cancer mortality remains to be established.