Does age influence the behaviour of localized prostate cancer?

Objective To assess, in a meta-analysis of published studies, whether age influences the behavior of localized prostate cancer. Methods The Medline database was searched from 1966 to 2000 to identify studies analysing the outcome of localized prostate cancer by age, using disease-specific outcome measures, and having controlled for the established prognostic factors of grade, T stage and, where available, serum prostate-specific antigen (PSA) level. Results In all, 34 studies were identified, which included a total of 27 551 patients. The incomplete and heterogeneous nature of the reports precluded any quantitative overview. The findings of these reports are described and methodological shortcomings discussed. Conclusion The evidence suggests that young age was an adverse prognostic factor in some series of radiation therapy before the advent of PSA assays, when men typically presented clinically with locally advanced disease, but that age has no significant prognostic effect in contemporary series of localized prostate cancer. Possible explanations for this difference are discussed, together with implications for further studies.