Prostate Cancer in Young Men
Prostate Cancer in Young Men
Abstract & Commentary
By William B. Ershler, MD
Synopsis: Examining SEER data, Lin et al found that young patients with locally advanced or high-grade prostate cancer had shorter overall and prostate cancer-specific survival when compared to similarly staged older patients. In contrast, younger patients with lower-grade and lower-stage tumors were found to have better overall survival and equivalent prostate cancer-specific survival compared to older patients. In certain ways, the findings are comparable to the age/prognosis differences observed for women with breast cancer.
Source: Lin DW, et al. Treatment and survival outcomes in young men diagnosed with prostate cancer. A population-based color study. Cancer. 2009;115:2863-2871.
It is a commonly held notion that the occurrence of breast cancer in young women confers an increased risk for negative outcomes independent of stage, grade, hormone receptor status, or mode of primary therapy.1 In contrast, in relatively short-term, single-institution studies, it has been reported that younger patients with prostate cancer have better biochemical, progression-free survival after prostatectomy.2,3 Yet, for those treated with external beam radiation, older age (> 60 years) was associated with lower biochemical recurrence rates. To reconcile this, Lin et al performed an analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Results database. For this, they examined the association between age at diagnosis and grade, stage, treatment, and survival outcomes in men who were diagnosed during the era of prostate-specific antigen (PSA) testing. Men (aged 35-74 years) who were diagnosed with prostate cancer between 1988 and 2003 were stratified by age at diagnosis to examine differences in tumor characteristics, treatment, and survival within each age group.
In total, 318,774 men were identified who had been diagnosed with adenocarcinoma of the prostate during this 15-year period. The proportion of men aged < 55 years at diagnosis increased over the study period from 2.3% between the years 1988 and 1991 to 9% between the years 2000 and 2003, and the median age at diagnosis decreased from 72 years in 1988 to 68 years in 2003. Younger men were more likely to be African-American, and were diagnosed less frequently with organ-confined tumors (p < .001), but were less likely to be diagnosed with high-grade cancer (p < .001). Older men were more likely to receive no local therapy or external beam radiation than young men (p < .001 for trend). Among men who had tumors with a Gleason score between 5 and 7, overall survival was worse with advancing age. However, among all age groups with high grade and stage, the youngest men (ages 35-44 years) were at the highest risk of all-cause and cancer-specific death.
Commentary
In summary, Lin et al's exploration of a database that is generally reflective of the U.S. cancer population confirmed that there is a shift toward younger age at diagnosis among men with prostate cancer, and that younger men were more likely to undergo prostatectomy. Furthermore, younger men were more likely to have lower-grade cancer and, as a group, better overall survival. In contrast to overall survival, the data indicate that prostate cancer-specific survival at 10 years was not different across the different age groups. Additionally, young men with high-grade tumors had significantly reduced overall and prostate cancer-specific survival, a finding that remained significant, even when controlling for potentially confounding factors such as type of therapy.
Unfortunately, for an analysis such as this, the SEER database does not include data on comorbidities. However, it is likely that such an analysis would only accentuate the most important finding of this report. If Lin et al had been able to adjust for comorbidity, it most likely would have increased the magnitude of the hazard ratios associated with the youngest age groups.
Although younger patients are more likely to tolerate aggressive treatments and are less likely to have competing morbidities, there remains the concern that young patients with various tumors have particularly aggressive disease. Certainly this is true for breast cancer, but it may also be observed for other tumor types, including colon cancer, certain lymphomas, and sarcoma.4 For breast, and now prostate, cancer, it would seem the logical explanation relates to the hormonal milieu and the likelihood that menopause (or andropause in men) provides a less fertile environment for rapid or progressive tumor growth.
References
1. Anders CK, et al. Breast cancer before age 40 years. Semin Oncol. 2009;36:237-249.
2. Freedland SJ, et al. Impact of obesity on biochemical control after radical prostatectomy for clinically localized prostate cancer: a report by the Shared Equal Access Regional Cancer Hospital database study group. J Clin Oncol. 2004;22:446-453.
3. Loeb S, et al. Progression after radical prostatectomy for men in their thirties compared to older men. BJU Int. 2008;101:1503-1506.
4. Bleyer A. Young adult oncology: the patients and their survival challenges. CA Cancer J Clin. 2007;57:242-255.
Examining SEER data, Lin et al found that young patients with locally advanced or high-grade prostate cancer had shorter overall and prostate cancer-specific survival when compared to similarly staged older patients.Subscribe Now for Access
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