Effects of Admission Age and Gleason Score on the State Transition in Elderly Patients With Prostate Cancer Using a Multi-State Model

Objectives: Cancer is one of the leading causes of death among the elderly in the world. There are several factors involved in the development and progression of cancer. Therefore, knowing these factors and how they affect the cancer patient’s process can help in timely treatment of the disease. This study aims to evaluate the effects of admission age and Gleason score on the state transition in elderly patients with prostate cancer. Methods & Materials: This is a historic cohort study conducted in 2018. The studied data are related to 125 elderly patients with prostate cancer (Mean±SD age= 72.12±7.32 years) who referred to the urology department of Imam Khomeini Hospital from 2004 to 2017 and underwent radical prostatectomy and were under different conditions (Radiation therapy, hormone therapy, or death) after surgery. The effect of admission age and Gleason score on the transition between states were tested using a multi-state model in R v.5.0 software. Results: Those who underwent surgery and treatment remained 4.5 years in the local recurrence state, 2 years in the distant recurrence state, and 6.5 years in the death state. People who had surgery were 17% more likely to metastasize and accept hormone therapy; 8.8% more likely to have a local recurrence and accept radiotherapy; and 8% more likely to experience death. The effect of Gleason score on the change of state was not significant, but the age variable was effective transition from surgical state to hormone therapy. Conclusion: In elderly patients who have undergone radical prostatectomy, the risk of metastasis increases with age.