310 Background: Benefit of ctx in elderly PC is unclear as they are under-represented in trials and most reports are retrospective series from academic centres. This population based study sought to examine the role of ctx in the elderly PC. Methods: Pts with diagnosis of PC between 1998 and 2010 inclusive who did not receive radical resection were identified from National Cancer Registry of Ireland database. Pts were divided into two age groups: ≥70 vs <70, and stratified based on metastatic status: M0 vs M1. Median overall survival (OS) was estimated with Kaplan-Meier method and hazard ratios (HR) with Cox regressional analysis. Results: A total of 4,509 pts were identified, of whom 2,875 (64%) were ≥70 yrs. For the entire group, 16% were staged M0, 42% were staged M1 and 42% didn't have documented staging (Mx). 16% received ctx, 5% chemoradiotherapy (crt) and 79% no cancer directed therapies. More pts ≥70 were Mx compared to <70 (48% vs 30%, p<.01); Mx pts were less likely to receive treatment than M0/M1 (88% vs 73% vs 73%, p<.01). Pts ≥70 were also less likely to receive any treatment (p<.01) (Table). Comparing the ≥70 and <70 groups, median OS (in months) for M0 who received ctx were 6.0 vs 7.3 (HR 1.28 [95% confidence interval 0.85-1.89], p=.24); received crt were 7.0 vs 9.7 (HR 0.95 [0.42-1.88] p=.89) and no treatment were 3.0 vs 3.5 (HR 1.03 [0.84-1.29] p=.75); median OS for M1 who received ctx were 2.4 vs 3.4 (HR 1.21 [0.97-1.49] p=.09), crt were 4.3 vs 6.0 (HR 1.69 [0.89-3.03] p = .11) and none were 1.2 vs 1.4 (HR 1.11 [1.00 – 1.24] p=.06). Regardless of age or M stage, cxt and crt conferred superior OS as compared to no treatment (Table). Conclusions: We observed a disparity in diagnostics and delivery of treatment to older pts with PC. Pts ≥70 who were treated benefited similarly to younger pts. Such therapeutic nihilism should be addressed in a systematic fashion. [Table: see text]