Introduction: There is a pervasive view within the urological community that prostate cancer occurring in younger men will be in some way different to the same disease occurring in an older man [1]. So far studies have either been relatively small [2], or use indirect techniques [3].
Objective: To determine if there are differences in the pathological characteristics of prostate cancer in younger men compared to the disease when it occurs in older men.
Methods: A retrospective cohort study was conducted using the prospectively collected prostate cancer database of a single large institution.
Results: Data was extracted for all prostate cancer cases between 2011–2017 in 11,551 men. 100 men were under 45 years old and 413 were under 50 years old. Univariate analysis was conducted using both age cut offs in order to minimise the risk of Type II errors.
Statistically significant differences were found in a number of pathological characteristics. Younger men had lower grade disease (average Grade Group 1.94 [under-45] F=42.8711, 11147df P<0.001, 2.15 [under-50] F=87,627.8711, 11147df P<0.001, versus 2.62), and lower stage disease (average stage 2b [under-45] F=29.0141, 11153df P<0.001, 2b [under-50] F=67.3741, 11153df P<0.001,versus 2c). Younger men also had less widespread disease within the prostate. There was no difference in lymph node positivity.
Additionally, a smaller proportion of younger men had anterior disease (37/59 [under 45], 174/272 [under-50] versus 6,121/7900). Although these differences were statistically significant (Pearson Chi-square 6.8871df, P=0.009 [under-45], 27.1271df, P>0.000 [under-50]), it is unclear if they are clinically significant.
Conclusions: This study is one of the largest of its kind to date. Preliminary results demonstrate that prostate cancer in younger men tends to be lower grade and stage disease compared to older men. This may have an impact on disease management in younger men.
1. Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol. 2014 Jun;11(6):317-323
2. Lin DW, Porter M, Montgomery B. Treatment and survival outcomes in young men diagnosed with prostate cancer: a population based cohort study. Cancer. 2009;115(13):2863-2871
3. Milonas D, Venclovas Z, Gudinaviciene I, Zviniene K, Matjosaitis AJ. Long-Term Oncological Outcomes for Young Men Undergoing Radical Prostatectomy for Localized Prostate Cancer. BioMed Research International. 2017;2017:9858923
