Study refutes beliefs about young prostate cancer patients

Orlando, FL-New data appear to refute the suggestion that young men diagnosed with prostate cancer are more likely to have aggressive disease. In fact, younger men show better progression-free survival than older men, according to the data, based on outcomes analyses for a population of surgically treated men with early-onset prostate cancer.

Urologists from Johns Hopkins University, Baltimore, reviewed their institution's radical prostatectomy database for the years 1975 to 2007 to identify men who received no hormonal or radiation therapy prior to surgery and had complete follow-up data. A total of 8,968 patients fulfilled the inclusion criteria, and they were then categorized into five subgroups by decade of age. Statistical analyses compared a subgroup of 42 men in their 30s against their older counterparts with respect to clinical and pathologic characteristics and disease-related outcomes. In addition, the study included 893 men age 40 to 49 years; 4,085 men age 50 to 59; 3,766 men age 60 to 69; and 182 men age 70 and older.

The results, presented at the AUA annual meeting here, showed the 30-to 39-year-old men had more favorable pathologic features and better progression-free survival rates than their older counterparts did. In addition, a multivariate analysis controlling for other prognostic variables showed age in the 30s was independently associated with a lower risk of biochemical progression, reported Stacy Loeb, MD, a urology resident at Johns Hopkins working with Misop Han, MD, and colleagues.

"The results showing these young men have relatively favorable features and outcomes are very encouraging. This information supports the concept that early, aggressive surgical treatment is a viable management option for these patients with a long life expectancy."

The comparisons of clinical and pathologic features showed the men in their 30s were similar compared with their older counterparts with respect to PSA, biopsy Gleason score, and clinical stage. Median PSA for the youngest men was 4.0 ng/mL, 86% had a biopsy Gleason score of 6 or less, and almost two-thirds had clinical stage T1c disease or lower.

The proportion of men with organ-confined disease decreased monotonically across the various age strata, and when the data were pooled for all men ages 40 and older, the rate of organ-confined disease was significantly lower among men in their 30s compared with those 40 and above: 81% versus 62%, respectively. Similarly, a significant difference was seen favoring the younger men in analysis of the proportions with extraprostatic extension (19% vs. 37%, respectively), as well as a trend for a lower rate of positive surgical margins (5% vs. 14%, respectively).

Using the Kaplan-Meier method, biochemical progression-free survival rates worsened with increasing age. In the statistical analysis, men in their 30s had a significantly higher 5-year biochemical progression-free survival rate compared with their older counterparts: 95% versus 83%, respectively. A multivariate analysis was also performed to predict biochemical progression while controlling for other clinical variables. The results showed age was an independent risk factor, with older men (ages 40+) having a 4.3-fold greater hazard ratio for biochemical progression compared with the men in their 30s.

"Our study may be affected by selection bias, since men with more aggressive disease might be more likely to opt for other forms of treatment, such as radiation therapy," Dr. Loeb noted.