Men who undergo radical prostatectomy (RP) for Gleason score 6 prostate cancer (PCa) are more likely to have adverse pathologic features found at the time of surgery if they are older than 65 years, a study found.

The prospective investigation, which included 3191 men, found that patients older than 65 years had significant 28% increased odds of adverse pathologic findings at RP compared with patients aged 65 years or less after adjusting for potential confounders, Daniel W. Kim, MD, MBA, of Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, and colleagues reported in JAMA Network Open.

“These findings suggest that men older than 65 years with biopsy-confirmed Gleason score 6 prostate cancer may benefit from additional testing, such as multiparametric magnetic resonance imaging and targeted biopsy before proceeding with active surveillance,” Dr Kim’s team concluded. “If higher grade or stage disease is detected, this information could be used to guide the use and duration of androgen deprivation therapy in men considering radiotherapy.”

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Of the 3191 men, 1075 were older than 65 years and 2116 were aged 65 years or less. The groups did not differ with regard to median baseline PSA levels (6.90 and 6.65 ng/mL, respectively). The authors defined adverse pathologic findings as TNM category pT3/T4 or R1 or Gleason score 8, 9, or 10 tumors.

Possible explanations for why advancing age is associated with an elevated risk for adverse pathologic findings include sampling error and undergrading as a consequence of benign prostatic hyperplasia that occurs normally with aging, Dr Kim and his colleagues noted. In addition, older men are more likely than younger men to have lower testosterone levels at the time of PCa diagnosis, and it is known that PCa in hypogonadal men can be more aggressive compared with PCa in men with normal testosterone levels.


Kim DW, Chen MH, Huland H, et al. Association of age with risk of adverse pathological findings at radical prostatectomy in men with Gleason score 6 prostate cancer [published online April 1, 2020]. JAMA Netw Open.  3(4):e202041. doi: 10.1001/jamanetworkopen.2020.2041