Prostate cancer in men aged less than 50 years at diagnosis
Prostate cancer (CaP) in younger men (age ≤50 years) appears to present differently compared with older men. This study describes CaP characteristics and outcomes in Australian young men.
The South Australian Prostate Cancer Clinical Outcomes Collaborative database was used to identify men diagnosed with CaP 1998–2012. Men were stratified by age at diagnosis into groups ≤50, 50–70 and ≥70 years. Primary outcomes of cumulative biochemical recurrence (BCR) and cumulative prostate cancer-specific mortality (PCSM) were assessed at 5 and 10 years.
In total, 7018 men were included. At time of diagnosis, 182 (2.6 %) were aged ≤50 years. Median follow-up exceeded 4 years. Younger men had a greater proportion of T stage <2 disease, lower median PSA and higher rates of Gleason score <7 (all p < 0.001). They were more likely to experience active surveillance (AS) (4.9, 3.1, 1.5 %) or radical prostatectomy (RP) (70, 55, 8 %) and less likely radiotherapy (13, 24, 29 %) as their principal modality (all p < 0.001). Although only 4.9 % underwent AS, 48 % of men ≤50 years were eligible for AS. Men ≤50 years had both the lowest unadjusted cumulative BCR and PCSM at 10 years. After multivariate analysis, BCR was not significantly different. Sample size limited multivariate analysis of PCSM.
In our cohort, men ≤50 years with CaP had less aggressive clinical characteristics, but were more likely to undergo RP. They appear to experience lower unadjusted PCSM, but similar rates of adjusted BCR. Further studies are needed to assess whether AS is appropriately utilised in these men.
KeywordsProstate cancer Young men Biochemical recurrence Mortality
Data included in this study have been obtained from the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database which has received funding from: Movember, the Urological Society of Australia and New Zealand, the Repat Foundation, the Hospital Research Foundation (Australian Prostate Cancer Research), Tolmar, the South Australian Health and Medical Research Institute Breast Cancer initiative, Lions Australia and the Rebecca L Cooper Medical Research Foundation.
NJ Kinnear, G Kichenadasse and D Foreman contributed to project development and manuscript writing. S Plagakis helped in manuscript editing. ME O’Callaghan contributed toproject development, data analysis and manuscript editing. T Kopsaftis contributed to data collection and data management. S Walsh contributed to data management.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants
This retrospective cohort analysis analysed the characteristics and outcomes of patients already enrolled in SA-PCCOC database. This study has ethics approval from the Southern Adelaide Clinical Human Research Ethics Committee, a joint committee of the Southern Adelaide Local Health Network and Flinders University.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required. Nevertheless, this study has ethics approval from the Southern Adelaide Clinical Human Research Ethics Committee, a joint committee of the Southern Adelaide Local Health Network and Flinders University.
Informed consent was not obtained from participants included in the study. Enrolment to the SA-PCCOC database uses an opt-out system for recruitment as recommended by the Australian National Statement on Ethical Conduct in Human Research (2007)—Updated May 2015.
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