Prostate cancer (PCa) diagnosis is not uncommon in younger men, and the proportion of patients with PCa aged <50 years old (yo) has increased to 5% in the PSA era.
Clinically, although the majority of cases are diagnosed with low risk disease, their extended life expectancy exposes them to long-term risk of disease progression resulting in death from prostate cancer.
The 3 recognized risk factors for prostate cancer are increasing age, African American race, and a family history (FH).
Data about PCa treatment outcomes are controversial, younger men are likely to have a more aggressive disease and carry a worse prognosis.
The twofold aim of our study was to compare the young group (YG) (G1) (≤ 55 yo) vs. adult group (AG) (G2) (>56 yo) who underwent RP for PCa between 2010-2016 when it comes to FH, race and tumor aggressiveness and secondly to determine if the PCa in YG is more aggressive and prevalent when there is a PCa familiar background.
Between 2010-2016, 419 patients men underwent RP for clinically localized PCa at CHLisboa Central. We identified 49 men aged ≤55 years at time of RP.
Clinical characteristics such as race, FH, PSA level, clinical stage, and biopsy Gleason score (BGS) were reported before RP. Pathological parameters (pathological stage, Gleason score) and PSA follow-up were collected after surgery.
In G1, 31% had PCa FH vs. 10% in G2 (p<0.001).
In BGS, 44.3% had Gleason (G) 6, 37.4% G7, 6.9% G≥8, without significant diferences between the two groups (p=0.651). Meanwhile, G1 had more aggressive tumors after RP: 27% G6, 45% G7 e 29% G≥8 vs. 37%, 53% e 11% respectively in G2 (p=0.002).
Biochemical recorrence (BCR) was higher in G1 20% vs. 9% (p=0.010).
In a multivariate logistic regression model, the G1 had more BCR (p=0.047) and more PCa FH incidence (p=0.002).
When comparing African vs. Caucasian men, the first group had more aggressive tumors after RP (p=0.021).
Our study demonstrated that young men had superior pathological grades with higher BCR rates. Also, there is a strong relationship between the young group and FH of PCa. Data regarding pathological findings after RP in young men are still controversial.
The present study is not devoid of limitations. It is a non-randomized retrospective study with a small sample and a relatively short follow-up but intends to add content to the scientific debate around PCa theme.