Clinicopathologic Analysis of Prostate Cancer in Men Age 45 or Younger: A Review of a Single Institution.
Javier A Laurini, Tilcia Lopez, John C Cheville, R Jeffrey Karnes, Thomas J Sebo, Rafael E Jimenez. Mayo Clinic, Rochester, MN
Background: Some prior studies of prostate cancer in men age 45 years or younger (PCa≤45) suggested that these patients (pts) had a less favorable outcome. However, most of these studies were performed before PSA screening programs. We studied a cohort of PCa≤45 treated by radical prostatectomy (RP) and analyzed pathological and clinical differences between PCa≤45 and older pts.
Design: RP specimen slides from cases of PCa≤45 that underwent RP at our institution from 1987 to 2007 were reviewed for Gleason score (GS), tumor location, and histologic subtype. Original GS, PSA level, pathologic stage, margin status (and a score combining these factors – GPSM score), pre- and post RP therapy, were compared with the remaining (older) pts in the registry. Biochemical failure (BCF) rates were compared using Kaplan-Meier (KM) analysis. Cox regression model was used for multivariate analysis.
Results: Of 16,551 RP at our institution in the study period, 181 (1.09%) were for PCa≤45. 168 had available slides for review, on which 72.6 % had a GS ≤6, 9 and 3 cases showed mucinous and ductal features, respectively, and 14 cases showed involvement of the anterior/transition zone. 82.3 % had negative margin status and 88.9 % were organ-confined. Over the study period, a significant increase in the number of PCa≤45 undergoing RP was noted (1 pt in 1987 vs 17 in 2007; p<0.0001). PCa≤45 when compared to older men had a lower median preoperative PSA (4.4 vs 6.2 ng/ml; p <0.0001); seminal vesicle involvement (4.4% vs 11.8%; p=0.0022); lymph node metastases (2.3% vs 6%; p=0.0370); positive surgical margins (17.7% vs 28.6%; p=0.0012); lower pathologic stage (p=0.0001); GS (p=0.0248); and were less likely to receive hormonal (5% vs 13.9%; p=0.0005) or radiation (5.5% vs 10.6%; p=0.0274) therapy for recurrent disease. KM analysis revealed a lower rate of BCF in PCa≤45.
On multivariate analysis, this difference was not significant once age at diagnosis was controlled for year of surgery and GPSM score.
Conclusions: Diagnosis of PCa≤45 has increased steadily over the years. PCa≤45 is not associated with unique morphologic or topographic features; however, pts with PCa at this young age are more likely to be associated with favorable pathologic findings upon diagnosis.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:30 PM
Platform Session: Section A, Monday Afternoon