To the Editor: Dr Lu-Yao and colleagues1 investigated 10-year survival rates in a large contemporary sample of older men with conservatively treated early prostate cancer. This study did not find an inverse association between age and prostate cancer aggressiveness.
Although a post hoc analysis of a randomized trial suggested lower aggressiveness of prostate cancer in older men (lower incidence of metastases and lower disease-specific mortality in the watchful waiting group in men aged 65 years or older),2 the role of age in prostate cancer survival is still controversial. After radical prostatectomy, higher age may be associated with adverse outcomes.3 Unfortunately, samples representing one specific prostate cancer treatment option are influenced by selection (for instance, a possible enrichment of high-risk tumors in older surgical patients and, conversely, of low-risk cancers in younger conservatively treated cohorts).
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