The Association Between Age, Prostate Cancer Risk, and Higher Gleason Score in a Long-term Screening Program: Results from the Göteborg-1 Prostate Cancer Screening Trial

Abstract

Background: Studies have suggested associations between greater age, increased risk of prostate cancer (PC), and higher Gleason score.

Objective: The present study aimed at investigating these associations within the Göteborg-1 randomized, population-based PC screening trial.

Design, setting, and participants: The screening arm of the Göteborg-1 screening trial comprises 10000 randomly selected men (aged 50-64 yr at randomization) from the Göteborg region of Sweden. Between 1995 and 2014, they were biennially invited to prostate-specific antigen (PSA) testing to an upper age limit of 70 yr (range 67-71 yr). PSA ≥3 ng/ml triggered a prostate biopsy (sextant biopsy 1995-2009, thereafter a ten-core biopsy).

Outcome measurements and statistical analysis: The impact of age on Gleason score, given a screen-detected PC, was investigated with multinomial logistic regression analyses adjusted for year of testing and screening round.

Results and limitations: Overall, 7625 men had at least one PSA test and 1022 men were diagnosed with PC. For men with screen-detected PC, age was associated with the risk of clinically significant PC above and beyond screening round and year of testing (p < 0.001). For each 1-yr increase in age, the risk of being diagnosed with a Gleason score ≥3 + 4 cancer (vs <7) increased by 11% (95% confidence interval [CI] 4.7-17), whereas the risk of being diagnosed with a Gleason score ≥4 + 3 cancer (vs <7) increased by 8.5% (95% CI -1.6 to 20).

Conclusions: The increased risk of a higher Gleason score in older men should be considered when counseling men regarding early diagnosis and treatment for PC.

Patient summary: We found that older age increased both the risk of prostate cancer and the risk of more aggressive prostate cancer.

Keywords: Age; Gleason score; Incidence; Prostate cancer; Screening.