Impact of age on clinical presentation, treatment, and cancer-specific survival of patients with small-cell carcinoma of the prostate

BACKGROUND: The effects of age on clinical presentation, treatment, and outcomes for patients with small-cell carcinoma of the prostate (SCCP) are unclear. METHODS: A retrospective review was performed on 259 patients who were identified with SCCP in the national Surveillance, Epidemiology, and End Results (SEER) registry from January 1973 to December 2004. The patients were categorized into two groups according to age at diagnosis, ie, younger than 75 years (n = 158, 61%) or 75 years and older (n = 101, 39%). Patient and treatment characteristics and cancer-specific survival were compared between the groups. Multivariate analysis was performed to identify independent prognostic factors associated with cancer-specific survival. RESULTS: The median age of the patients was 72 (30–95) years. There was no significant difference in terms of tumor characteristics, concomitant adenocarcinoma grade, SEER stage, and treatment (including prostatectomy and radiation therapy) received between the groups. Median cancer-specific survival was 19 months (95% confidence interval 13–25). By multivariate Cox proportional hazard modeling, older age group (hazard ratio [HR] 1.95; P = 0.001), concomitant high-grade adenocarcinoma (HR 7.13; P = 0.007), and not having prostatectomy (HR 3.77; P = 0.005) were found to be significant independent predictors of poor cancer-specific survival. CONCLUSION: Older patients with SCCP had increased risk of poor cancer-specific survival. Whether this age-related poor outcome can be attributed to more aggressive tumor biology in older patients, or is simply a refection of age-related poor performance status and suboptimal chemotherapy needs further investigation.