Effect of frailty measures on overall survival in prostate cancer: A systematic review and meta-analysis.

5077 Background: Prostate cancer at all stages is associated with a favorable prognosis and treatment is generally well tolerated, including in the elderly. Frailty screening tools such as the Geriatric 8 (G8) have been associated with decreased survival across different cancers. However, the effect of frailty on overall survival (OS) in prostate cancer is poorly understood. Methods: A comprehensive search of PubMed, Embase, and Scopus was performed through December 2025 for studies evaluating the impact of frailty on OS in patients with prostate cancer. Data were analyzed in two distinct cohorts: patients with metastatic castration-resistant prostate cancer (mCRPC) and those with unspecified prostate cancer (PC) (at any stage). Meta-analysis was performed using a random-effects model to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I² statistic and Chi² test. Results: Of the twelve studies that met the inclusion criteria, two were excluded due to non-availability of survival statistics for analysis. Four studies could not be included in the meta-analysis as hazard ratios were not reported. A total of 7120 patients across seven studies were included in the meta-analysis. In the mCRPC cohort (n=4 studies), frailty was a significant predictor of mortality, associated with a pooled HR of 2.16 (95% CI: 1.34–3.49; P = 0.002). Moderate-to-high heterogeneity was observed in this group (I² = 65%). In the unspecified PC cohort (n=2 studies), the association between frailty and OS did not reach statistical significance, yielding a pooled HR of 1.74 (95% CI: 0.69–4.40; P = 0.24). Heterogeneity for the unspecified PC group was I² = 61%. Conclusions: Frailty is associated with increased mortality in elderly patients with metastatic castration-resistant prostate cancer. This effect of frailty was not statistically significant when the population was expanded to include early-stage prostate cancer. These results highlight the importance of geriatric screening for prognostic assessment in elderly patients with prostate cancer, especially in those with metastatic castration-resistant disease. Study characteristics and hazard ratios for overall survival. Study Cancer type Design N Age Assessment tool Frailty % OS Beardo (2019) mCRPC RS 70 ≥75 G8 NR 3.13 (1.13–8.66) Banna (2022) mCRPC PS 234 78 G8 38% 3.58 (1.72–7.49) Wilk (2022) mCRPC PS 49 71 G8 47% 2.24 (1.15–4.36) Deol (2023) mCRPC RS 5822 75.4 VA-FI 39.70% 1.44 (1.35–1.52) Royset (2023) PC PS 73 73.6 EFS 24.60% 1.27 (1.20–1.35) Siwakoti (2024) PC PS 70 70 CARE-FI 21% 3.55 (1.01–12.47) Abbreviations: Retrospective study (RS); Prospective study (PS); Sample size (N); Geriatric 8 (G8); Veterans Affairs Frailty Index (VA-FI); Edmonton Frail Scale (EFS); Cancer and Aging Resilience Evaluation Frailty Index (CARE-FI); Not reported (NR).