1
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Li J, Cai Z, Wei W, Wang X, Peng X. Establishment of Prognostic Nomograms for Early-Onset Prostate Cancer Patients: A SEER Database Analysis. J INVEST SURG 2022; 35:1581-1590. [PMID: 35414345 DOI: 10.1080/08941939.2022.2062495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Clinical prostate cancer (PCa) is rare in men aged <50 years (early-onset). A well-designed nomogram for prognosis prediction in patients with early-onset PCa has not been studied. Here, we tried to establish nomogram models of overall survival (OS) and cancer-specific survival (CSS) in patients with early-onset PCa. METHODS The clinical variables of patients diagnosed with early-onset PCa between 2004 and 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation groups at a ratio of 7:3. Multivariate Cox regression analyses were used to select prognostic factors associated with OS or CSS, followed by the construction and validation of nomograms. RESULTS We enrolled 8259 patients with early-onset PCa. New nomograms were established and showed good discriminative abilities. Finally, ROC curve analysis demonstrated that these nomograms were superior to the TNM stage and Gleason score in predicting both OS and CSS for patients with early-onset PCa. CONCLUSION This is the first study to establish nomograms with effective and high accuracy for prognosis in patients with early-onset PCa.
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Affiliation(s)
- Jingtao Li
- Department of Urology, The Second Affiliated Hospital of Jianghan University, Wuhan, China
| | - Zhen Cai
- Department of Operation Room, The Second Affiliated Hospital of Jianghan University, Wuhan, China
| | - Wei Wei
- Department of Urology, The Second Affiliated Hospital of Jianghan University, Wuhan, China
| | - Xia Wang
- Department of Pharmacy, The Second Affiliated Hospital of Jianghan University, Wuhan, Hubei, China
| | - Xiulan Peng
- Department of Oncology, The Second Affiliated Hospital of Jianghan University, Wuhan, China
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2
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Soltani MH, Khabazian R, Dadpour M, Borumandnia N, Simforoosh N. Comparison of histopathological features, survival, and oncological outcome between patients under and above 55-year-old with prostate cancer who underwent radical prostatectomy. Urologia 2022; 90:83-88. [PMID: 35191332 DOI: 10.1177/03915603221078266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: To compare the disease course, histopathological features and survival rates of prostate cancer (PCa) between patients aged ⩽ 55 and > 55 year old. Materials and methods: In this retrospective study, we enrolled 644 patients with organ-confide prostate cancer who had undergone radical prostatectomy from 2005 to 2018. Seventy-six (11.8%) patients were under 55 years of age (group 1) and 568 (88.2%) patients were >55 years old (group 2). Results: Pre-operative hypertension was detected in 4 (5.3%) patients of group 1 and 80 (14.1%) patients of groups 2 ( p = 0.029). The mean (±SD) prostate volume was higher in group 2 compared with group 1 (34.1(±8.4) ml vs 54.1(±9.9) ml, p < 0.001). Positive surgery margin was observed in 15 (19.7%) and 58 (10.2%) patients in group 1 and 2, respectively ( p = 0.020). Co-existence of diabetes mellitus, mean pre-operative PSA, Gleason’s score, and permanent pathology and pathologic stage were similar between the two groups. Log-rank test failed to show any statistical difference in terms of biochemical-relapse free survival, local recurrence-free survival, and metastasis-free survival between the two groups ( p = 0.316, 0.441, 0.654, respectively). After performing multivariate analysis, positive surgical margin was the only factor that was independently predictive of biochemical relapse ( p < 0.001) and local recurrence/metastasis ( p < 0.001). Conclusion: No difference was observed in terms of histopathologic features, biochemical relapse, and local recurrence/metastasis-free survival rates between patients younger and older than 55 years of age.
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Affiliation(s)
- Mohammad Hossein Soltani
- Shahid Beheshti University of Medical Sciences, Labbafinejad Hospital, Urology and Nephrology Research Center, Tehran, Iran
| | - Reza Khabazian
- Shahid Beheshti University of Medical Sciences, Urology and Nephrology Research Center, Tehran, Iran
| | - Mehdi Dadpour
- Shahid Beheshti University of Medical Sciences, Urology and Nephrology Research Center, Tehran, Iran
| | - Nasrin Borumandnia
- Shahid Beheshti University of Medical Sciences, Urology and Nephrology Research Center, Tehran, Iran
| | - Nasser Simforoosh
- Shahid Beheshti University of Medical Sciences, Labbafinejad Hospital, Urology and Nephrology Research Center, Tehran, Iran
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3
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Baniak N, Sholl LM, Mata DA, D'Amico AV, Hirsch MS, Acosta AM. Clinicopathological and molecular characteristics of prostate cancer diagnosed in young men aged up to 45 years. Histopathology 2021; 78:857-870. [PMID: 33306242 DOI: 10.1111/his.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
AIMS To characterise and compare the poorly understood clinicopathological and molecular characteristics of prostatic adenocarcinoma (PCa) in very young patients. METHODS AND RESULTS We compared the clinicopathological and molecular characteristics of PCa diagnosed in 90 patients aged ≤45 years with those of PCa diagnosed in 200 patients of typical screening age (i.e. 60-65 years). Patients diagnosed at a younger age had a higher frequency of a family history of PCa and lower prostate-specific antigen (PSA) levels than those diagnosed at regular screening age. There were no statistically significant differences in clinical stage or pathological characteristics of the core biopsy specimens between the groups. Young patients had a higher frequency of Grade Group 1 disease at radical prostatectomy. A subset of 13 aggressive PCa cases from young patients underwent successful DNA-based next-generation sequencing. In all, 46.2% (6/13) had TMPRSS2 rearrangements and 23.1% (3/13) had relevant pathogenic variants in DNA damage repair genes, including a mismatch repair-deficient case with biallelic inactivation of MLH1. No statistically significant differences were observed in PCa-specific recurrence/progression between the younger and older patients, including after adjustment for clinical stage, PSA level, and Grade Group. CONCLUSIONS In this study, the clinicopathological and molecular features of PCa diagnosed in young patients were comparable to those of PCa diagnosed in patients of screening age. Early-onset PCa cases were not enriched in any of the known molecular PCa subtypes in this small series.
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Affiliation(s)
- Nicholas Baniak
- Department of Pathology, Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Molecular Pathology Division (Center for Advanced Molecular Diagnostics), Brigham and Women's Hospital, Boston, MA, USA
| | | | - Anthony V D'Amico
- Department of Radiation Oncology, Genitourinary Radiation Oncology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle S Hirsch
- Department of Pathology, Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andres M Acosta
- Department of Pathology, Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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4
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Zheng Y, Lin SX, Wu S, Dahl DM, Blute ML, Zhong WD, Zhou X, Wu CL. Clinicopathological characteristics of localized prostate cancer in younger men aged ≤ 50 years treated with radical prostatectomy in the PSA era: A systematic review and meta-analysis. Cancer Med 2020; 9:6473-6484. [PMID: 32697048 PMCID: PMC7520296 DOI: 10.1002/cam4.3320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives With the rapid increase in younger age prostate cancer (PCa) patients, the impact of younger age on decision‐making for PCa treatment needs to be revaluated in the new era. Materials and Methods A systematic literature search was performed using PubMed, EMBASE, and Web of Science up to October 2019 to identify the eligible radical prostatectomy (RP) studies focusing on understanding the impact of age on clinicopathological features and oncological prognosis in patients with localized PCa in PSA era. Meta‐analyses were conducted using available hazard ratios (HRs) from both univariate and multivariate analyses. Results Twenty‐six studies including 391 068 patients with RP treatments from the PSA era were included. Of these studies, age of 50 years old (age50) is the most commonly used cut‐off age to separate the younger patient group (including either age < 50 or age ≤ 50) from the older patient group. In these studies, the incidence of younger patients varied between 2.6% and 16.6% with a median of 8.3%. Younger patients consistently showed more favorable clinicopathological features correlated with better BCR prognosis. Meta‐analyses showed a 1.38‐fold improved BCR survival of younger patients in multivariate analysis. Among the high‐risk PCa patients, younger age was independently associated with worse oncological outcomes in multivariate analyses. Conclusion In this study, we found younger age correlated with favorable clinicopathological characteristics and better BCR prognosis in low‐ to intermediate‐risk patients. In high‐risk group patients, younger patients often showed significantly worse oncological outcomes. Our study results suggest that age 50 could be used as a practical cut‐off age to separate younger age patients from older age PCa patients.
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Affiliation(s)
- Yu Zheng
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei-De Zhong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xing Zhou
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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5
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Lu Y, Huang HH, Lau WKO. Survival outcomes of Asian younger men (< 55 years) undergoing radical prostatectomy: a review of prostate cancer database in a tertiary hospital in Singapore. Int Urol Nephrol 2020; 52:1885-1891. [PMID: 32476081 DOI: 10.1007/s11255-020-02518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Prostate cancer largely affects older men. This study aims to investigate prostate cancer in younger men (< 55 years) to shed light on the survival outcomes of this unique subset of patients in Asian context. METHODS Data were obtained from the Singapore General Hospital Prostate Cancer Registry. Data on all men with clinically organ confined prostate cancer who underwent radical prostatectomy between 1998 and 2016 were obtained from the registry. Tumor characteristics, follow-up data, and cause of death were acquired. RESULTS A total of 1120 men underwent radical prostatectomy between 1998 and 2016. Of these, 12 were aged ≤ 44 years, 106 were aged 45-54 years, 596 were aged 55-64, 397 were aged 65-74 and 9 were aged ≥ 75. There was no difference across age groups when comparing Gleason ≤ 7 vs Gleason ≥ 8 disease, T1/2 vs T3/4 disease and the median PSA values were similar. No difference was observed in overall survival or prostate cancer specific survival among 4 age groups (≤ 44, 45-54, 55-64, 65-74) (p = 0.156 and p = 0.227 respectively). Although there was a trend of increasing rate of biochemical recurrence for older patients, it's not statistically significant (p = 0.157). Time to biochemical recurrence was similar as well (p = 0.257). CONCLUSION This large cohort of Asian patients who underwent radical prostatectomy did not show significant age-related differences in important parameters and outcomes.
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Affiliation(s)
- Yadong Lu
- Department of Urology, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Weber Kam On Lau
- Department of Urology, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
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6
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Chung MS, Shim M, Cho JS, Bang W, Kim SI, Cho SY, Rha KH, Hong SJ, Koo KC, Lee KS, Chung BH, Lee SH. Pathological Characteristics of Prostate Cancer in Men Aged < 50 Years Treated with Radical Prostatectomy: a Multi-Centre Study in Korea. J Korean Med Sci 2019; 34:e78. [PMID: 30886549 PMCID: PMC6417998 DOI: 10.3346/jkms.2019.34.e78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Recently, younger prostate cancer (PCa) patients have been reported to harbour more favourable disease characteristics after radical prostatectomy (RP) than older men. We analysed young men (<50 years) with PCa among the Korean population, paying attention to pathological characteristics on RP specimen and biochemical recurrence (BCR). METHODS The multi-centre, Severance Urological Oncology Group registry was utilized to identify 622 patients with clinically localized or locally advanced PCa, who were treated with RP between 2001 and 2017. Patients were dichotomized into two groups according to age (< 50-year-old [n = 75] and ≥ 50-year-old [n = 547]), and clinicopathological characteristics were analysed. Propensity score matching was used when assessing BCR between the two groups. RESULTS Although biopsy Gleason score (GS) was lower in younger patients (P = 0.033), distribution of pathologic GS was similar between the two groups (13.3% vs. 13.9% for GS ≥ 8, P = 0.191). There was no significant difference in pathologic T stage between the < 50- and ≥ 50-year-old groups (69.3% vs. 68.0% in T2 and 30.7% vs. 32.0% in ≥ T3, P = 0.203). The positive surgical margin rates were similar between the two groups (20.0% vs. 27.6%, P = 0.178). BCR-free survival rates were also similar (P = 0.644) between the two groups, after propensity matching. CONCLUSION Contrary to prior reports, younger PCa patients did not have more favourable pathologic features on RP specimen and showed similar BCR rates compared to older men. These findings should be considered when making treatment decisions for young Korean patients with PCa.
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Affiliation(s)
- Mun Su Chung
- Department of Urology, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Woojin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Sung Yong Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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7
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Gielchinsky I, Chang J, Cusick T, Delprado W, Nguyen Q, Yuen C, Savdie R, Böhm M, Haynes AM, Scheltema MJ, Stricker PD. Prostate cancer in 432 men aged <50 years in the prostate-specific antigen era: a new outlook. BJU Int 2018; 122 Suppl 5:35-41. [DOI: 10.1111/bju.14586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ilan Gielchinsky
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - John Chang
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Thomas Cusick
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology; Macquarie Park NSW Australia
- School of Medicine; University of New South Wales; Kensington NSW Australia
| | - Quoc Nguyen
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Carlo Yuen
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
| | - Richard Savdie
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Matthijs J. Scheltema
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Phillip D. Stricker
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- School of Medicine; University of New South Wales; Kensington NSW Australia
- St Vincent's Clinic; Sydney NSW Australia
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8
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Talton W, Lindner H, Rovito MJ. Increasing Urologic Care Ratios: Implications of Male Patient Care in Florida. Am J Mens Health 2018; 12:2029-2036. [DOI: 10.1177/1557988316664904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ongoing trends have revealed an inverse relationship between population growth and the number of practicing urologists in the U.S. per capita, which threatens urologic care accessibility. Furthermore, different regions in the United States may be more negatively impacted due to higher population growth rates. The state of Florida witnessed over a 10% higher growth rate compared with national figures between 2000 and 2015. Coupled with data suggesting that since the 1980s, the number of U.S. urologists per capita has been decreasing, the foreseeable future presents many challenges regarding health equity and accessibility. This secondary analysis aimed to investigate the implications of forecasted urologic care decline within a growing population and how it can contribute to adverse male health outcomes. National- and state-level data were collected to calculate a series of urologic care ratios as defined by the number of urologists compared with population sizes. Analyses revealed that national-level urologic care ratios and prostate cancer incidence rates have a significant positive relationship, lending to the conclusion that with fewer urologists, the number of cases identified will decrease. State-level forecasted models indicated that the urologic care ratio will decrease approximately 30% in Florida from 6.23 per 100,000 in 2010 to 4.39 per 100,000 by the year 2030. As growth in demand for urologic care will increase in the next decade, a dire public health scenario is potentially unfolding. Future implications of undiagnosed prostate cancer due to the lack of access will drive an increase in mortality rates as well as health equity concerns for men.
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9
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Gielchinsky I, Scheltema MJ, Cusick T, Chang J, Shnier R, Moses D, Delprado W, Nguyen Q, Yuen C, Haynes AM, Stricker PD. Reduced sensitivity of multiparametric MRI for clinically significant prostate cancer in men under the age of 50. Res Rep Urol 2018; 10:145-150. [PMID: 30324096 PMCID: PMC6174906 DOI: 10.2147/rru.s169017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Three percent of all new diagnosed prostate cancer (PC) patients are under the age of 50. Multiparametric MRI (mpMRI) is considered as increasingly powerful tool for decision-making in diagnosis of PC and in some active surveillance protocols. Since prostate architecture changes with age, we evaluated the sensitivity of mpMRI to detect clinically significant PC in patients under the age of 50 compared to pair-matched older patients. Methods Data from a prospective collected and ethics approved database were retrospectively analyzed. We reviewed 1,395 records of PC patients from the years 2012–2017, identifying those under the age of 50 who had radical prostatectomy as primary treatment, a pre-operative mpMRI, a full clinical data set and who had clinically significant cancer (N=51). Tumor size and International Society of Urological Pathology (ISUP) score pair-matching was performed for patients older than 55 years. Clinically significant cancer was defined as ISUP >2 or ISUP 2 with >5% Gleason 4. The sensitivity to detect clinically significant cancer with mpMRI was calculated using pre-operative Prostate Imaging Reporting and Data System (PI-RADS) score and whole-gland final pathology. Results The median patient age in the young and older groups was 47 and 62, respectively. Both cohorts matched significantly regarding tumor volume (P =0.91) and ISUP score (P =1.0). The median PI-RADS score for the young group was 3, and 4 for the older group. The sensitivity for mpMRI, for PI-RADS 3,4 and 5 was 80.3% (95% CI 66.8%–90.1%) in the young group and 84.3% in the older group (95% CI 71.4%–92.9%), demonstrating no statistically significant difference (P=0.603). Sensitivity of mpMRI for PI-RADS 4,5 was 49.0% (95% CI 34.7%–63.4%) for the young group and 72.5% (95% CI 58.2%–84.1%) for the older group, which differ significantly (P=0.014). Conclusions mpMRI may have a reduced sensitivity for detecting clinically significant PC in patients under the age of 50 for PI-RADS score 4,5 lesions. Many significant PC lesions were reported as PI-RADS 3 under the age of 50. We recommend that increased significance is placed on PI-RADS 3 lesions found in patients under the age of 50.
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Affiliation(s)
- Ilan Gielchinsky
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia, .,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia,
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia,
| | - Thomas Cusick
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia,
| | - John Chang
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia, .,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia,
| | - Ron Shnier
- Southern Radiology, Randwick, NSW, Australia.,School of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Daniel Moses
- School of Medicine, University of New South Wales, Kensington, NSW, Australia.,Spectrum Radiology, Randwick, NSW, Australia
| | - Warick Delprado
- School of Medicine, University of New South Wales, Kensington, NSW, Australia.,Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Quoc Nguyen
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia,
| | - Carlo Yuen
- School of Medicine, University of New South Wales, Kensington, NSW, Australia.,St Vincent's Clinic, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia,
| | - Phillip D Stricker
- Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia, .,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia, .,School of Medicine, University of New South Wales, Kensington, NSW, Australia.,St Vincent's Clinic, Sydney, NSW, Australia
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10
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Tumor characteristics, treatments, and oncological outcomes of prostate cancer in men aged ≤50 years: a population-based study. Prostate Cancer Prostatic Dis 2018; 21:71-77. [DOI: 10.1038/s41391-017-0006-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/09/2017] [Indexed: 12/19/2022]
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11
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Prendeville S, Nesbitt ME, Evans AJ, Fleshner NE, van der Kwast TH. Variant Histology and Clinicopathological Features of Prostate Cancer in Men Younger than 50 Years Treated with Radical Prostatectomy. J Urol 2017; 198:79-85. [DOI: 10.1016/j.juro.2017.01.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Susan Prendeville
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery (MEN, NEF), University Health Network, Toronto, Ontario, Canada
| | - Michael E. Nesbitt
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery (MEN, NEF), University Health Network, Toronto, Ontario, Canada
| | - Andrew J. Evans
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery (MEN, NEF), University Health Network, Toronto, Ontario, Canada
| | - Neil E. Fleshner
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery (MEN, NEF), University Health Network, Toronto, Ontario, Canada
| | - Theodorus H. van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery (MEN, NEF), University Health Network, Toronto, Ontario, Canada
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12
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Jamshidi N, Margolis DJ, Raman S, Huang J, Reiter RE, Kuo MD. Multiregional Radiogenomic Assessment of Prostate Microenvironments with Multiparametric MR Imaging and DNA Whole-Exome Sequencing of Prostate Glands with Adenocarcinoma. Radiology 2017; 284:109-119. [PMID: 28453432 DOI: 10.1148/radiol.2017162827] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To assess the underlying genomic variation of prostate gland microenvironments of patients with prostate adenocarcinoma in the context of colocalized multiparametric magnetic resonance (MR) imaging and histopathologic assessment of normal and abnormal regions by using whole-exome sequencing. Materials and Methods Six patients with prostate adenocarcinoma who underwent robotic prostatectomy with whole-mount preservation of the prostate were identified, which enabled spatial mapping between preoperative multiparametric MR imaging and the gland. Four regions of interest were identified within each gland, including regions found to be normal and abnormal via histopathologic analysis. Whole-exome DNA sequencing (>50 times coverage) was performed on each of these spatially targeted regions. Radiogenomic analysis of imaging and mutation data were performed with hierarchical clustering, phylogenetic analysis, and principal component analysis. Results Radiogenomic multiparametric MR imaging and whole-exome spatial characterization in six patients with prostate adenocarcinoma (three patients, Gleason score of 3 + 4; and three patients, Gleason score of 4 + 5) was performed across 23 spatially distinct regions. Hierarchical clustering separated histopathologic analysis-proven high-grade lesions from the normal regions, and this reflected concordance between multiparametric MR imaging and resultant histopathologic analysis in all patients. Seventy-seven mutations involving 29 cancer-associated genes across the 23 spatially distinct prostate samples were identified. There was no significant difference in mutation load in cancer-associated genes between regions that were proven to be normal via histopathologic analysis (34 mutations per sample ± 19), mildly suspicious via multiparametric MR imaging (37 mutations per sample ± 21), intermediately suspicious via multiparametric MR imaging (31 mutations per sample ± 15), and high-grade cancer (33 mutations per sample ± 18) (P = .30). Principal component analysis resolved samples from different patients and further classified samples (regardless of histopathologic status) from prostate glands with Gleason score 3 + 4 versus 4 + 5 samples. Conclusion Multiregion spatial multiparametric MR imaging and whole-exome radiogenomic analysis of prostate glands with adenocarcinoma shows a continuum of mutations across regions that were found via histologic analysis to be high grade and normal. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Neema Jamshidi
- From the Departments of Radiological Sciences (N.J., S.R., M.D.K.) and Urology (R.E.R.), University of California, Los Angeles-David Geffen School of Medicine, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721; Department of Radiology, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY (D.J.M.); Department of Pathology, Duke University School of Medicine, Durham, NC (J.H.); and College of Electrical and Computer Engineering, National Chiao Tung University, HsinChu, Taiwan (M.D.K.)
| | - Daniel J Margolis
- From the Departments of Radiological Sciences (N.J., S.R., M.D.K.) and Urology (R.E.R.), University of California, Los Angeles-David Geffen School of Medicine, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721; Department of Radiology, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY (D.J.M.); Department of Pathology, Duke University School of Medicine, Durham, NC (J.H.); and College of Electrical and Computer Engineering, National Chiao Tung University, HsinChu, Taiwan (M.D.K.)
| | - Steven Raman
- From the Departments of Radiological Sciences (N.J., S.R., M.D.K.) and Urology (R.E.R.), University of California, Los Angeles-David Geffen School of Medicine, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721; Department of Radiology, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY (D.J.M.); Department of Pathology, Duke University School of Medicine, Durham, NC (J.H.); and College of Electrical and Computer Engineering, National Chiao Tung University, HsinChu, Taiwan (M.D.K.)
| | - Jiaoti Huang
- From the Departments of Radiological Sciences (N.J., S.R., M.D.K.) and Urology (R.E.R.), University of California, Los Angeles-David Geffen School of Medicine, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721; Department of Radiology, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY (D.J.M.); Department of Pathology, Duke University School of Medicine, Durham, NC (J.H.); and College of Electrical and Computer Engineering, National Chiao Tung University, HsinChu, Taiwan (M.D.K.)
| | - Robert E Reiter
- From the Departments of Radiological Sciences (N.J., S.R., M.D.K.) and Urology (R.E.R.), University of California, Los Angeles-David Geffen School of Medicine, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721; Department of Radiology, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY (D.J.M.); Department of Pathology, Duke University School of Medicine, Durham, NC (J.H.); and College of Electrical and Computer Engineering, National Chiao Tung University, HsinChu, Taiwan (M.D.K.)
| | - Michael D Kuo
- From the Departments of Radiological Sciences (N.J., S.R., M.D.K.) and Urology (R.E.R.), University of California, Los Angeles-David Geffen School of Medicine, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721; Department of Radiology, Weill Cornell Imaging, New York-Presbyterian Hospital, New York, NY (D.J.M.); Department of Pathology, Duke University School of Medicine, Durham, NC (J.H.); and College of Electrical and Computer Engineering, National Chiao Tung University, HsinChu, Taiwan (M.D.K.)
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Are the Pathological Characteristics of Prostate Cancer More Aggressive or More Indolent Depending upon the Patient Age? BIOMED RESEARCH INTERNATIONAL 2017; 2017:1438027. [PMID: 28265568 PMCID: PMC5318620 DOI: 10.1155/2017/1438027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/07/2017] [Accepted: 01/12/2017] [Indexed: 12/16/2022]
Abstract
Purpose. To identify pathological characteristics of prostate cancer according to patient age at diagnosis. Methods. A retrospective review of 2,929 men diagnosed with prostate cancer was performed. Pathological characteristics were compared across age groups: ≤55, 56–75, and >75 years. Results. The study cohort included 133 patients (4.5%), 2,033 patients (69.5%), and 763 patients (26.0%) in the three age groups, respectively. The median pathological Gleason sums in the three age groups were 8, 7, and 8, respectively. The Gleason sum, primary Gleason score, and second primary Gleason score were significantly different among the three age groups (Z = 12.975, p = 0.002; Z = 9.264, p = 0.010; Z = 6.692, p = 0.035, resp.). The percentages of Gleason pattern 5 tumors for the three age groups were 44.4%, 32.3%, and 36.8%, respectively; they were significantly different (χ2 = 11.641, p = 0.003). The percentages of tumors with Gleason score grade groups 3–5 for the three age groups were 66.9%, 60.5%, and 66.3%, respectively; they were significantly different (χ2 = 9.401, p = 0.009). Conclusions. The present study indicated that men aged ≤55 years or >75 years show higher levels of clinically significant prostate cancer compared to patients between the ages of 55 and 75 years. Younger and more elderly male patients are more likely to have a more aggressive disease.
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Kinnear NJ, Kichenadasse G, Plagakis S, O’Callaghan ME, Kopsaftis T, Walsh S, Foreman D. Prostate cancer in men aged less than 50 years at diagnosis. World J Urol 2016; 34:1533-1539. [DOI: 10.1007/s00345-016-1824-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/02/2016] [Indexed: 12/16/2022] Open
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15
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Moul JW. Population Screening for Prostate Cancer and Early Detection. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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De Bari B, Daidone A, Alongi F. Is high dose rate brachytherapy reliable and effective treatment for prostate cancer patients? A review of the literature. Crit Rev Oncol Hematol 2015; 94:360-70. [DOI: 10.1016/j.critrevonc.2015.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 12/16/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022] Open
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17
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High-throughput transcriptomic analysis nominates proteasomal genes as age-specific biomarkers and therapeutic targets in prostate cancer. Prostate Cancer Prostatic Dis 2015; 18:229-36. [PMID: 25986914 PMCID: PMC4579590 DOI: 10.1038/pcan.2015.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/30/2015] [Accepted: 04/04/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although prostate cancer (PCa) is hypothesized to differ in nature between younger versus older patients, the underlying molecular distinctions are poorly understood. We hypothesized that high-throughput transcriptomic analysis would elucidate biological differences in PCas arising in younger versus older men, and would nominate potential age-specific biomarkers and therapeutic targets. METHODS The high-density Affymetrix GeneChip platform, encompassing >1 million genomic loci, was utilized to assess gene expression in 1090 radical prostatectomy samples from patients with long-term follow-up. We identified genes associated with metastatic progression by 10 years post-treatment in younger (age<65) versus older (age⩾65) patients, and ranked these genes by their prognostic value. We performed Gene Set Enrichment Analysis (GSEA) to nominate biological concepts that demonstrated age-specific effects, and validated a target by treating with a clinically available drug in three PCa cell lines derived from younger men. RESULTS Over 80% of the top 1000 prognostic genes in younger and older men were specific to that age group. GSEA nominated the proteasome pathway as the most differentially prognostic in younger versus older patients. High expression of proteasomal genes conferred worse prognosis in younger but not older men on univariate and multivariate analysis. Bortezomib, a Food and Drug Administration approved proteasome inhibitor, decreased proliferation in three PCa cell lines derived from younger patients. CONCLUSIONS Our data show significant global differences in prognostic genes between older versus younger men. We nominate proteasomeal gene expression as an age-specific biomarker and potential therapeutic target specifically in younger men. Limitations of our study include clinical differences between cohorts, and increased comorbidities and lower survival in older patients. These intriguing findings suggest that current models of PCa biology do not adequately represent genetic heterogeneity of PCa related to age, and future clinical trials would benefit from stratification based on age.
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18
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Caffo O, Ortega C, Di Lorenzo G, Sava T, De Giorgi U, Cavaliere C, Macrini S, Spizzo G, Aieta M, Messina C, Tucci M, Lodde M, Mansueto G, Zucali PA, Alesini D, D'Angelo A, Massari F, Morelli F, Procopio G, Ratta R, Fratino L, Lo Re G, Pegoraro MC, Zustovich F, Vicario G, Ruatta F, Federico P, La Russa F, Burgio SL, Maines F, Veccia A, Galligioni E. Clinical outcomes in a contemporary series of "young" patients with castration-resistant prostate cancer who were 60 years and younger. Urol Oncol 2015; 33:265.e15-21. [PMID: 25907622 DOI: 10.1016/j.urolonc.2015.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognosis of younger patients with prostate cancer is unclear, and the very few studies assessing those with metastatic castration-resistant prostate cancer (mCRPC) have mainly involved patients treated with older therapies. The aim of this observational study was to evaluate the clinical outcomes of a contemporary series of docetaxel-treated patients with mCRPC who were 60 years and younger. PATIENTS AND METHODS We retrospectively identified 134 patients who were 60 years and younger who were treated with docetaxel in 25 Italian hospitals and recorded their predocetaxel history of prostate cancer, their characteristics at the start of chemotherapy, and their postdocetaxel treatment history and outcomes. RESULTS Most of the 134 consecutive patients with mCRPC received the standard 3-week docetaxel schedule; median progression-free survival (PFS) was 7 months, and 90 patients underwent further therapies after progression. The median overall survival (OS) from the start of docetaxel treatment was 21 months, but OS was significantly prolonged by the postprogression treatments, particularly those based on the new agents such as cabazitaxel, abiraterone acetate, or enzalutamide. OS was significantly shorter in the patients with a shorter interval between the diagnosis of prostate cancer and the start of docetaxel treatment; those who received hormonal treatment for a shorter period; those with shorter prostate-specific antigen doubling times; and those with lower hemoglobin levels, a worse performance status, and higher lactate dehydrogenase levels before starting treatment with docetaxel. CONCLUSIONS The findings of this first study of clinical outcomes in a contemporary series of younger patients with mCRPC showed that their survival is similar to that expected in unselected patients with mCRPC who were of any age.
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Affiliation(s)
- Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy.
| | - Cinzia Ortega
- Medical Oncology Department, Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Giuseppe Di Lorenzo
- Oncologia Urologica, Azienda Ospedaliera Universitaria "Federico II", Napoli, Italy
| | - Teodoro Sava
- Medical Oncology Department, General Hospital, Verona, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS, Meldola, Italy
| | - Carla Cavaliere
- Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Sveva Macrini
- Medical Oncology Department, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Gilbert Spizzo
- Medical Oncology Department, General Hospital, Merano, Italy
| | - Michele Aieta
- Medical Oncology Department, Referral Cancer Center of Basilicata-IRCCS, Rionero in Vulture, Italy
| | - Caterina Messina
- Medical Oncology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marcello Tucci
- Medical Oncology Department, San Luigi Hospital, University of Torino, Orbassano, Italy
| | - Michele Lodde
- Urology Department, General Hospital, Bolzano, Italy
| | | | - Paolo Andrea Zucali
- Department of Medical Oncology and Haematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Daniele Alesini
- Department of Radiological, Oncological and Anatomopathological Sciences, La Sapienza, University of Rome, Rome, Italy
| | | | - Francesco Massari
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Franco Morelli
- Medical Oncology Department, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Procopio
- Oncologia medica genitourinaria-Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Raffaele Ratta
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - Lucia Fratino
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Giovanni Lo Re
- Medical Oncology Department, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Fable Zustovich
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Giovanni Vicario
- Medical Oncology Department, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
| | - Fiorella Ruatta
- Medical Oncology Department, Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Piera Federico
- Oncologia Urologica, Azienda Ospedaliera Universitaria "Federico II", Napoli, Italy
| | | | - Salvatore Luca Burgio
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST)-IRCCS, Meldola, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Enzo Galligioni
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
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Hussein S, Satturwar S, Van der Kwast T. Young-age prostate cancer. J Clin Pathol 2015; 68:511-5. [DOI: 10.1136/jclinpath-2015-202993] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 12/14/2022]
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20
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Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol 2014; 11:317-23. [PMID: 24818853 PMCID: PMC4191828 DOI: 10.1038/nrurol.2014.91] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prostate cancer is considered a disease of older men (aged >65 years), but today over 10% of new diagnoses in the USA occur in young men aged ≤55 years. Early-onset prostate cancer, that is prostate cancer diagnosed at age ≤55 years, differs from prostate cancer diagnosed at an older age in several ways. Firstly, among men with high-grade and advanced-stage prostate cancer, those diagnosed at a young age have a higher cause-specific mortality than men diagnosed at an older age, except those over age 80 years. This finding suggests that important biological differences exist between early-onset prostate cancer and late-onset disease. Secondly, early-onset prostate cancer has a strong genetic component, which indicates that young men with prostate cancer could benefit from evaluation of genetic risk. Furthermore, although the majority of men with early-onset prostate cancer are diagnosed with low-risk disease, the extended life expectancy of these patients exposes them to long-term effects of treatment-related morbidities and to long-term risk of disease progression leading to death from prostate cancer. For these reasons, patients with early-onset prostate cancer pose unique challenges, as well as opportunities, for both research and clinical communities. Current data suggest that early-onset prostate cancer is a distinct phenotype-from both an aetiological and clinical perspective-that deserves further attention.
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Affiliation(s)
- Claudia A. Salinas
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Miriam Ishak-Howard
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kathleen A. Cooney
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
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Kimura T, Onozawa M, Miyazaki J, Matsuoka T, Joraku A, Kawai K, Nishiyama H, Hinotsu S, Akaza H. Prognostic impact of young age on stage IV prostate cancer treated with primary androgen deprivation therapy. Int J Urol 2014; 21:578-83. [DOI: 10.1111/iju.12389] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/02/2013] [Indexed: 01/26/2023]
Affiliation(s)
- Tomokazu Kimura
- Department of Urology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Mizuki Onozawa
- Department of Urology; Tokyo-kita Social Insurance Hospital; Tokyo Japan
| | - Jun Miyazaki
- Department of Urology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Taeko Matsuoka
- Department of Urology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Akira Joraku
- Department of Urology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Koji Kawai
- Department of Urology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Hiroyuki Nishiyama
- Department of Urology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Shiro Hinotsu
- Center for Innovative Clinical Medicine; Okayama University; Okayama Japan
| | - Hideyuki Akaza
- Department of Strategic Investigation on Comprehensive Cancer Network; Research Center for Advanced Science and Technology; University of Tokyo; Tokyo Japan
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22
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Ismail AAA. Identifying and reducing potentially wrong immunoassay results even when plausible and "not-unreasonable". Adv Clin Chem 2014; 66:241-94. [PMID: 25344990 DOI: 10.1016/b978-0-12-801401-1.00007-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The primary role of the clinical laboratory is to report accurate results for diagnosis of disease and management of illnesses. This goal has, to a large extent been achieved for routine biochemical tests, but not for immunoassays which remained susceptible to interference from endogenous immunoglobulin antibodies, causing false, and clinically misleading results. Clinicians regard all abnormal results including false ones as "pathological" necessitating further investigations, or concluding iniquitous diagnosis. Even more seriously, "false-negative" results may wrongly exclude pathology, thus denying patients' necessary treatment. Analytical error rate in immunoassays is relatively high, ranging from 0.4% to 4.0%. Because analytical interference from endogenous antibodies is confined to individuals' sera, it can be inconspicuous, pernicious, sporadic, and insidious because it cannot be detected by internal or external quality assessment procedures. An approach based on Bayesian reasoning can enhance the robustness of clinical validation in highlighting potentially erroneous immunoassay results. When this rational clinical/statistical approach is followed by analytical affirmative follow-up tests, it can help identifying inaccurate and clinically misleading immunoassay data even when they appear plausible and "not-unreasonable." This chapter is largely based on peer reviewed articles associated with and related to this approach. The first section underlines (without mathematical equations) the dominance and misuse of conventional statistics and the underuse of Bayesian paradigm and shows that laboratorians are intuitively (albeit unwittingly) practicing Bayesians. Secondly, because interference from endogenous antibodies is method's dependent (with numerous formats and different reagents), it is almost impossible to accurately assess its incidence in all differently formulated immunoassays and for each analytes/biomarkers. However, reiterating the basic concepts underpinning interference from endogenous antibodies can highlight why interference will remain analytically pernicious, sporadic, and an inveterate problem. The following section discuses various stratagems to reduce this source of inaccuracy in current immunoassay results including the role of Bayesian reasoning. Finally, the role of three commonly used follow-up affirmative tests and their interpretation in confirming analytical interference is discussed.
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Becker A, Tennstedt P, Hansen J, Trinh QD, Kluth L, Atassi N, Schlomm T, Salomon G, Haese A, Budaeus L, Michl U, Heinzer H, Huland H, Graefen M, Steuber T. Functional and oncological outcomes of patients aged <50 years treated with radical prostatectomy for localised prostate cancer in a European population. BJU Int 2013; 114:38-45. [DOI: 10.1111/bju.12407] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Andreas Becker
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Pierre Tennstedt
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Jens Hansen
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Quoc-Dien Trinh
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Luis Kluth
- Department of Urology; University-Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Nabil Atassi
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Thorsten Schlomm
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Georg Salomon
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Alexander Haese
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Lars Budaeus
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Uwe Michl
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Hans Heinzer
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Hartwig Huland
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Steuber
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
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Song J, Park H, Lee G. Contribution of genetic variation rs266882 to prostate-specific antigen levels in healthy controls with serum PSA below 2.0 ng/ml. Biochem Genet 2013; 51:264-74. [PMID: 23315126 DOI: 10.1007/s10528-012-9561-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 11/15/2012] [Indexed: 12/01/2022]
Abstract
We evaluated the impact of genetic variation in the prostate-specific antigen (PSA) gene (rs266882) on serum PSA levels in healthy men as well as risk factors for benign prostate hypertrophy (BPH) and prostate cancer. The study population comprised 91 men with PSA levels below 2.0 ng/ml as healthy controls, 78 men with PSA 2-10 ng/ml as a BPH group, and 128 prostate cancer patients, all in Korea. DNA was amplified by polymerase chain reaction and the product was sequenced. We found that PSA levels were associated with a G/A polymorphism only in healthy controls. The transition, however, was not associated with PSA levels of BPH and cancer patients, nor was it a risk factor. In conclusion, this genetic factor is important for determining serum PSA levels in the naive group, whereas the disruption of prostatic architecture in BPH or prostate cancer may be a major determining factor for PSA levels.
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Affiliation(s)
- Jaeman Song
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea
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25
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Hoffman RM, Barry MJ, Roberts RG, Sox HC. Reconciling primary care and specialist perspectives on prostate cancer screening. Ann Fam Med 2012; 10:568-71. [PMID: 23149535 PMCID: PMC3495932 DOI: 10.1370/afm.1399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
When specialists propose screening guidelines for primary care clinicians to implement, differences in perspectives between the 2 groups can create conflicts. Two recent specialty organization guidelines illustrate this issue. The American Urological Association guideline panel and National Comprehensive Cancer Network recommend that average-risk men first be counseled about the risks and benefits of prostate-specific antigen screening for prostate cancer at age 40 rather than at the previously recommended age of 50 years. There is no direct evidence, however, that this recommendation has any impact on prostate cancer-specific mortality. To avoid distracting primary care clinicians from providing services with proven benefit and value for patients, professional organizations should follow appropriate standards for developing guidelines. Primary care societies and health care systems should also be encouraged to evaluate the evidence and decide whether implementing the recommendations are feasible and appropriate.
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Affiliation(s)
- Richard M Hoffman
- Medicine Service, Albuquerque VA Medical Center, Departments of Medicine and Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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Clinicopathologic features of prostate cancer in patients diagnosed by age 45 who underwent radical prostatectomy. Eur Urol 2012; 62:354-5. [PMID: 22648059 DOI: 10.1016/j.eururo.2012.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/11/2012] [Indexed: 11/30/2022]
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Younger age is an independent predictor for poor survival in patients with signet ring prostate carcinoma. Prostate Cancer 2011; 2011:216169. [PMID: 22110982 PMCID: PMC3216005 DOI: 10.1155/2011/216169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 05/15/2010] [Accepted: 05/30/2010] [Indexed: 12/27/2022] Open
Abstract
Objective. The aim of this study was to examine the epidemiology, natural history, treatment pattern, and predictors of long-term survival of signet ring prostate carcinoma (SRPC) patients based on the analysis of the national Surveillance, Epidemiology, and End Results (SEER) database. Methods & Results. Between 1980 and 2004, a total of 93 patients with pathologically confirmed SRPC were identified. The mean age was 70 ± 11 years old. 82.8% of the patients had poorly or undifferentiated histology grade. 13.9% patients presented with metastatic disease. The 1-, 3-, and 5-year cancer-specific survival rates were 94.6%, 89.6%, and 83.8%, respectively. Using multivariate Cox proportional hazard model, younger age (40-50 versus age >70 yrs, P = .01), advanced tumor stage (distant versus local/regional, P = .02), and earlier diagnosis year (before 1995 versus after 1995, P = .01) were predictors of worse cancer specific survival. Conclusions. Despite more aggressive cancer therapy, younger SRPC patients had a worse cancer specific survival. This information could be useful when counseling these patients and emphasizes the need for new strategies and molecular-based therapeutic approaches for younger patients with SRPC.
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Younger patients have poorer biochemical outcome after radical prostatectomy in high-risk prostate cancer. Asian J Androl 2011; 13:719-23. [PMID: 21706038 DOI: 10.1038/aja.2011.39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to investigate the prognostic significance of patient age with respect to tumour aggressiveness in men who underwent radical prostatectomy (RP) for prostate cancer. In this study, we reviewed the records of 743 patients who received RP without neoadjuvant or adjuvant therapy at our institution and were followed up for >2 years postoperatively. For our analyses, the patients were divided into two groups according to age: younger (<60 years) and older (≥60 years). Through uni- and multivariate analyses, associations of various clinicopathological parameters, including biochemical recurrence-free survival, with patient age, were evaluated among all patients, and the patients were stratified according to their D'Amico risk classification. Among all subjects, younger (n=126) and older (n=617) patients showed no significant differences regarding pathological parameters and biochemical recurrence-free survival (P=0.288). For the high-risk group (n=206), younger patients had a lower rate of biochemical recurrence-free survival following surgery than older patients (P=0.017), despite the fact that no significant differences were observed regarding various known prognostic parameters between the two age groups. In addition, multivariate analysis revealed that age was an independent predictor of biochemical recurrence-free survival among the high-risk group (P=0.003). Our results showed that relatively younger patients have a comparable biochemical outcome compared with their older counterparts following RP performed for prostate cancer. However, among patients with high-risk disease, younger patients have a worse biochemical outcome following RP compared with older patients.
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Börgermann C, vom Dorp F, Swoboda A, Ketteniß O, Becker M, Rübben H. PSA Quo Vadis? It Is Reasonable to Start with Prostate-Specific Antigen Testing at the Age of 40! Cancer Epidemiol Biomarkers Prev 2011; 20:1190-5. [DOI: 10.1158/1055-9965.epi-10-1198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Parker PM, Rice KR, Sterbis JR, Chen Y, Cullen J, McLeod DG, Brassell SA. Prostate cancer in men less than the age of 50: a comparison of race and outcomes. Urology 2011; 78:110-5. [PMID: 21397300 DOI: 10.1016/j.urology.2010.12.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/20/2010] [Accepted: 12/25/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare clinicopathologic features and survival outcomes for men 50 years of age in relation to other age groups stratified by race to further define prostate cancer (CaP) in young men. Controversy exists regarding the appropriate age to undergo CaP screening, outcomes for early intervention, and whether there is unique age-associated tumor biology. We compared clinicopathologic features and survival outcomes for men <50 years of age in relation to other age groups stratified by race to further define CaP in young men. METHODS A multi-institutional review of 12,081 records of patients diagnosed with CaP from 1989-2009 was conducted. Patients were stratified by age group, race, and decade of treatment. Demographic and clinicopathologic characteristics were compared across age groups using chi-square tests and analysis of variance. The primary study endpoints, time to biochemical recurrence and all-cause mortality, were compared across age groups using Kaplan-Meier estimation and univariable and multivariable Cox proportional hazards analysis. RESULTS Only 4.5% of the study sample was <50 years of age. A higher percentage of African Americans diagnosed were <50 compared with Caucasians (8.3% vs 3.3%, P<.0001). Positive family history was more prevalent in the <50 cohort (36.1% vs 22.0%, P<.0001). Despite these findings, both racial subgroups for men<50 years of age demonstrated improved clinicopathologic features than other age quartiles. Furthermore, both Kaplan-Meier and Cox proportional hazard analysis demonstrated that the <50 cohort had a lower incidence of biochemical recurrence and greater overall survival. CONCLUSIONS Race and family history appear to play a significant role in the incidence of CaP in younger men. Younger age at diagnosis is associated with more favorable outcomes and indicates that population-based screening at younger ages could potentially lead to improved survival for high-risk groups.
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Affiliation(s)
- Patrick M Parker
- Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Ismail AAA, Ismail AA, Ismail Y. Probabilistic Bayesian reasoning can help identifying potentially wrong immunoassays results in clinical practice: even when they appear ‘not-unreasonable’. Ann Clin Biochem 2010; 48:65-71. [PMID: 21098546 DOI: 10.1258/acb.2010.010197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Immunoassays are susceptible to analytical interferences including from endogenous immunoglobulin antibodies at a rate of ∼0.4% to 4%. Hundreds of millions of immunoassay tests (>10 millions in the UK alone) are performed yearly worldwide for measurements of an array of large and small moieties such as proteins, hormones, tumour markers, rheumatoid factor, troponin, small peptides, steroids and drugs. Methods Interference in these tests can lead to false results which when suspected, or surmised, can be analytically confirmed in most cases. Suspecting false laboratory data in the first place is not difficult when results are gross and without clinical correlates. However, when false results are subtle and/or plausible, it can be difficult to suspect with adverse clinical sequelae. This problem can be ameliorated by using a probabilistic Bayesian reasoning to flag up potentially suspect results even when laboratory data appear “not-unreasonable”. Results Essentially, in disorders with low prevalence, the majority of positive results caused by analytical interference are likely to be false positives. On the other hand, when the disease prevalence is high, false negative results increase and become more significant. To illustrate the scope and utility of this approach, six different examples covering wide range of analytes are given, each highlighting specific aspect/nature of interference and suggested options to reduce it. Conclusion Bayesian reasoning would allow laboratorians and/or clinicians to extract information about potentially false results, thus seeking follow-up confirmatory tests prior to the initiation of more expensive/invasive procedures or concluding a potentially wrong diagnosis.
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Affiliation(s)
| | | | - Yasmin Ismail
- Severn and Bristol Royal Infirmary, Bristol, Avon, UK
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Gómez-Iturriaga Piña A, Crook J, Borg J, Lockwood G, Fleshner N. Median 5 Year Follow-up of 125Iodine Brachytherapy as Monotherapy in Men Aged ≤ 55 Years With Favorable Prostate Cancer. Urology 2010; 75:1412-6. [DOI: 10.1016/j.urology.2009.04.101] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/18/2009] [Accepted: 04/29/2009] [Indexed: 11/30/2022]
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Astigueta J, Abad M, Morante C, Pow-Sang M, Destefano V, Montes J. Patrón de presentación del cáncer de próstata avanzado en pacientes menores de cincuenta años. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Uhlman MA, Sun L, Stackhouse DA, Polascik TJ, Mouraviev V, Robertson CN, Albala DM, Moul JW. Tumor Percent Involvement Predicts Prostate Specific Antigen Recurrence After Radical Prostatectomy Only in Men With Smaller Prostate. J Urol 2010; 183:997-1001. [DOI: 10.1016/j.juro.2009.11.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Matthew A. Uhlman
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Leon Sun
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Danielle A. Stackhouse
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Polascik
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Valdmir Mouraviev
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Cary N. Robertson
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - David M. Albala
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Judd W. Moul
- Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Initial Prostate Specific Antigen 1.5 ng/ml or Greater in Men 50 Years Old or Younger Predicts Higher Prostate Cancer Risk. J Urol 2010; 183:946-50. [PMID: 20083275 DOI: 10.1016/j.juro.2009.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Indexed: 11/24/2022]
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Park SY, Lee HM. What Are Some New Developments in Prostate Cancer Diagnosis? JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010. [DOI: 10.5124/jkma.2010.53.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seo Yong Park
- Department of Urology, Sungkyunkwan University School of Medicine, Korea.
| | - Hyun Moo Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Korea.
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Kawada T, Muto K, Kanai T, Kuratomi Y. Prostate-specific antigen screening of workers under the age of 40 in Japan. Cancer Epidemiol 2009; 33:309-10. [PMID: 19716781 DOI: 10.1016/j.canep.2009.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 07/24/2009] [Accepted: 07/31/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no agreement on the usefulness of the prostate-specific antigen (PSA) test for prostate cancer screening in young men in Japan. We believe that medical check-up departments in hospitals conduct prostate cancer screening in subjects under 40 years of age undergoing intensive health check-up for commercial reasons, and speculate that some medical doctors provide tacit consent for this action. To understand the prevalence of PSA testing in young men, the authors examined the age distribution of workers who underwent the PSA test. METHODS The authors used the 2009 intensive health check-up data of male workers aged 30-65 years (n=298) in a car-manufacturing company to investigate the status of prostate-cancer screening in young men. Multiple comparison was conducted by Tukey's method when the analysis of variance revealed significant difference. RESULTS According to the frequency distribution of age, 15.8% of the subjects were under 40 years of age. The mean PSA value increased with age, ranging from 1.0 ng/mL in subjects in their 30s', to 2.0 ng/mL in subjects in their 60s'. The mean PSA level in subjects in their 60s' was significantly higher than that in subjects in their 30s' and 40s'. The percentage of subjects with serum PSA levels of 4 ng/mL or higher in subjects in their 30s', 40s', 50s' and 60s' were 2.1% (1/47), 1.6% (2/125), 4.4% (5/114) and 8.3% (1/12), respectively. CONCLUSIONS One-sixth of male workers attending the health check-up program were under 40 years of age. According to the criteria of the Japanese Urological Association, this examination program included younger subjects who were not candidates for PSA screening.
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Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo 113-8602, Japan.
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Börgermann C, Loertzer H, Luboldt HJ, Hammerer P, Fornara P, Graefen M, Rübben H. [PSA--Quo vadis?]. Urologe A 2009; 48:1008, 1010, 1012-4, passim. [PMID: 19680620 DOI: 10.1007/s00120-009-2076-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prostate cancer is the most frequent cancer in males. Because of the high cure rates, early detection of prostate cancer should identify organ-confined prostate cancers. An early detection examination should be performed annually starting at the age of 50 years and ending when life expectancy is less than 10 years. Digital rectal examination is supplemented by determination of prostate-specific antigen (PSA). Before the first PSA test, the patient must be informed of possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as the indication for prostate biopsy. Imaging methods do not play a major role in early detection of prostate cancer today. Early detection identifies many latent prostate cancers, and patients may receive overtreatment. A possible solution is to change the early detection paradigm from detection of all prostate cancers to identification of aggressive ones. In this article, early detection is discussed based on the recent literature.
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Affiliation(s)
- C Börgermann
- Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik, Hufelandstrasse 55, 45122, Essen, Germany.
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Lin DW, Porter M, Montgomery B. Treatment and survival outcomes in young men diagnosed with prostate cancer: a Population-based Cohort Study. Cancer 2009; 115:2863-71. [PMID: 19466697 DOI: 10.1002/cncr.24324] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Outcomes of treatment for young men compared with older men with prostate cancer are poorly defined outside of limited institutional series. In this study, the authors 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 testing. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to identify men who were diagnosed with prostate cancer between 1988 and 2003. Men ages 35 years to 74 years were stratified by age at diagnosis to examine differences in tumor characteristics, treatment, and survival within each age group. RESULTS In total, 318,774 men ages 35 years to 74 years were identified who had been diagnosed with adenocarcinoma of the prostate between 1988 and 2003. The proportion of men aged < or =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 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. CONCLUSIONS Age at diagnosis among men with prostate cancer continued to decline. Younger men were more likely to undergo prostatectomy, have lower grade cancer, and, as a group, to have better overall and equivalent cancer-specific survival at 10 years compared with older men. Among men with high grade and locally advanced prostate cancer, the youngest men had a particularly poor prognosis compared with older men.
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Affiliation(s)
- Daniel W Lin
- Department of Urology, Virginia Puget Sound Health Care System, University of Washington, Northwest Prostate Cancer Specialized Program of Research Excellence, Seattle, Washington, USA
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[Characteristics of prostate cancer in men less than 50-year-old]. Prog Urol 2009; 19:803-9. [PMID: 19945663 DOI: 10.1016/j.purol.2009.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 04/20/2009] [Accepted: 04/24/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report the characteristics of prostate cancer (PCa) in men less than 50-year-old and the results of different treatments of PCa in this population. METHOD A bibliographic research was performed using Pubmed database. The keywords that we used were: prostate cancer, age, young, radical prostatectomy, brachytherapy, radiotherapy, active surveillance. The studies which included a significant number of patients were selected. A total of 38 articles were used as bibliographic references. RESULTS PCa in young men does not seem to have different characteristics than in older men. Nevertheless, young men seem to have a lower risk of severe urinary and sexual sequelae, particularly following radical prostatectomy. CONCLUSIONS There is no recommendation regarding management of PCa in men less than 50-year-old. In case of localized cancer, two options may be considered. First option consists in decreasing the urinary and sexual complications of radical prostatectomy. A minimally-invasive treatment, such as brachytherapy or even active surveillance, may reach this objective. Second option consists in being more aggressive. To propose a radical prostatectomy offers to the patient the possibility of salvage radiation therapy in case of locally-advanced tumor or local recurrence.
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Hsu CY, Joniau S, Oyen R, Roskams T, Van Poppel H. Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer. Asian J Androl 2008; 11:131-7. [PMID: 19050679 DOI: 10.1038/aja.2008.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
According to the European Association of Urology (EAU) guidelines, a life expectancy of > 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy (RP), were previously detected by digital rectal examination (DRE). Patients were categorized into two age groups (< 65 and >or= 65 years old). Patients were also divided into two groups according to Charlson score ( = 0 and >or= 1). Both age and Charlson score were analyzed regarding their predictive power of patients' outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were < 65 years old and 94 patients were >or= 65 years old. Age was a significant predictor of overall survival (OS). A Charlson score of 0 was found in 110 patients, and of >or= 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS) or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.
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Affiliation(s)
- Chao-Yu Hsu
- Department of Urology, University Hospitals KULeuven, Leuven, Belgium
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Biochemical and Functional Outcomes Following Brachytherapy With or Without Supplemental Therapies in Men ≤50 Years of Age With Clinically Organ-Confined Prostate Cancer. Am J Clin Oncol 2008; 31:539-44. [DOI: 10.1097/coc.0b013e318172dcb7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scales CD, Antonelli J, Curtis LH, Schulman KA, Moul JW. Prostate-specific antigen screening among young men in the United States. Cancer 2008; 113:1315-23. [PMID: 18696715 DOI: 10.1002/cncr.23667] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Disagreement exists on the use of prostate-specific antigen (PSA) tests for cancer-risk stratification in young men in the United States. Little is known about the use of PSA testing in these men. To understand policy implications of risk stratification, the authors sought to characterize PSA use among young men. METHODS The authors used the 2002 Behavioral Risk Factor Surveillance System to study prostate-cancer screening in a representative sample of men aged 40 years and older (n = 58,511). The primary outcome was self-report of a PSA test in the previous year. RESULTS Among men aged 40 to 49 years, 22.5% (95% confidence interval [CI], 21.5-23.5) reported having had a PSA test in the previous year, compared with 53.7% (95% CI, 52.8-54.7; P < .001) of men aged >or=50 years. When sociodemographic characteristics were statistically controlled, young, black, non-Hispanic men were more likely than young, white, non-Hispanic men to report having had a PSA test in the previous year (odds ratio [OR], 2.42; 95% CI, 1.95-3.01; P < .001). In young men, annual household income >or=USD 35,000 (OR, 1.50; 95% CI, 1.26-1.78; P < .001) and an ongoing relationship with a physician (OR, 2.52; 95% CI, 2.06-3.07; P < .001) were associated with PSA testing. CONCLUSIONS One-fifth of young men reported having had a PSA test within the previous year. Young, black, non-Hispanic men are more likely than young, white, non-Hispanic men to report having had a PSA test, although screening in this high-risk group remains suboptimal.
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Affiliation(s)
- Charles D Scales
- Duke Prostate Center, Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA
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Hekal IA. The patients less than 50 years: is there a need to lower the PSA cutoff point? Prostate Cancer Prostatic Dis 2008; 12:148-51. [DOI: 10.1038/pcan.2008.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lane JA, Howson J, Donovan JL, Goepel JR, Dedman DJ, Down L, Turner EL, Neal DE, Hamdy FC. Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial. BMJ 2007; 335:1139. [PMID: 18006969 PMCID: PMC2099560 DOI: 10.1136/bmj.39381.436829.be] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the feasibility of testing for prostate cancer and the prevalence and characteristics of the disease in unselected young men. DESIGN Prospective cohort nested within a randomised controlled trial, with two years of follow-up. SETTING Eight general practices in a UK city. PARTICIPANTS 1299 unselected men aged 45-49. INTERVENTION Prostate biopsies for participants with a prostate specific antigen level of 1.5 ng/ml or more and the possibility of randomisation to three treatments for those with localised prostate cancer. MAIN OUTCOME MEASURES Uptake of testing for prostate specific antigen; positive predictive value of prostate specific antigen; and prevalence of prostate cancer, TNM disease stage, and histological grade (Gleason score). RESULTS 442 of 1299 men agreed to be tested for prostate specific antigen (34%) and 54 (12%) had a raised level. The positive predictive value for prostate specific antigen was 21.3%. Ten cases of prostate cancer were detected (2.3%) with eight having at least two positive results in biopsy cores and three showing perineural invasion. One tumour was of high volume (cT2c), Gleason score 7, with a positive result on digital rectal examination; nine tumours were cT1c, Gleason score 6, and eight had a negative result on digital rectal examination. Five of the nine eligible participants (55%) agreed to be randomised. No biochemical disease progression in the form of a rising prostate specific antigen level occurred in two years of follow-up. CONCLUSIONS Men younger than 50 will accept testing for prostate cancer but at a much lower rate than older men. Using an age based threshold of 1.5 ng/ml, the prevalence of prostate cancer was similar to that in older men (3.0 ng/ml threshold) and some cancers of potential clinical significance were found. TRIAL REGISTRATION Current Controlled Trials ISRCTN20141297.
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Affiliation(s)
- J Athene Lane
- Department of Social Medicine, University of Bristol
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Ford BS, Sharma S, Rezaishiraz H, Huben RS, Mohler JL. Effect of perioperative blood transfusion on prostate cancer recurrence. Urol Oncol 2007; 26:364-7. [PMID: 18367097 DOI: 10.1016/j.urolonc.2007.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/20/2007] [Accepted: 06/21/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transfusion may predispose patients to an increased risk of tumor recurrence following solid organ surgery. Lung and colon cancer studies suggest that blood transfusions promote tumor growth or distant metastasis possibly due to immunosuppression. Blood loss can be high during radical retropubic prostatectomy necessitating intraoperative and postoperative blood transfusion. The impact of blood transfusion on recurrence risk after radical retropubic prostatectomy remains uncertain. OBJECTIVE To determine the influence of allogeneic or autologous blood transfusion on prostate cancer recurrence in men undergoing radical retropubic prostatectomy and assess their prognostic significance using serum prostate-specific antigen (PSA) as an intermediate endpoint. METHODS Six hundred eleven men treated from 1987 to the present have had all clinical and follow-up data entered prospectively into a clinical database; 242 (40%) did not receive blood transfusion, 252 (41%) received autologous blood transfusion, and 117 (19%) received allogeneic blood transfusion. Biochemical failure was defined as PSA > 0.3 ng/ml on any follow-up visit. ANOVA, chi-square, and survival analyses were used to evaluate clinical characteristics and biochemical progression-free survival. RESULTS Patients participated for a mean of 44 months, range 1 to 170 months, until biochemical progression (78) or July 1, 2005 (533). Average estimated blood loss was 929 ml, 1573 ml, and 2,818 ml in the no blood transfusion, autologous blood transfusion, and allogeneic blood transfusion groups, respectively (P = 0.001). Patients in the allogeneic transfusion group were older, had higher preoperative PSA, higher stage disease, and greater blood loss. Biochemical failure rates were similar in the 3 groups (P = 0.42). Biochemical failure at 5 years occurred in 14% of men who did not receive blood transfusion, 10% of men who received autologous blood transfusion, and 16% of men who received allogeneic blood transfusion. No patient suffered clinical progression or prostate cancer death. CONCLUSIONS Autologous or allogeneic blood transfusions do not appear to influence the risk of biochemical failure in men with clinically localized prostate cancer treated with radical retropubic prostatectomy.
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Affiliation(s)
- Beneranda S Ford
- Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, NY 14203, USA.
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Magheli A, Rais-Bahrami S, Humphreys EB, Peck HJ, Trock BJ, Gonzalgo ML. Impact of patient age on biochemical recurrence rates following radical prostatectomy. J Urol 2007; 178:1933-7; discussion 1937-8. [PMID: 17868723 DOI: 10.1016/j.juro.2007.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE Increased age has been suggested to predict worse clinical outcomes in patients with prostate cancer. An explanation that was proposed for this observation is that it is due to inherent differences in the biological properties of prostate cancer in older men. Stage migration, prostate specific antigen and prostate biopsy pathology are variables that may confound the interpretation of age as an independent prognosticator of outcomes following radical prostatectomy. MATERIALS AND METHODS Matched pairs analysis was performed comparing the 3 age cohorts 46 to 55, 56 to 65 and older than 65 years to a cohort of 435 patients who were 45 years or younger based on propensity scores calculated with all known preoperative variables. Postoperative clinical and pathological characteristics were compared among the 4 matched age cohorts. A Cox hazards model was used to compare time to prostate specific antigen recurrence across the different age cohorts and the actuarial risk of recurrence was calculated using Kaplan-Meier and log rank survivor analyses. RESULTS Younger patients showed lower grade disease (p <0.001), and lower rates of positive surgical margin rates (p = 0.035) and extraprostatic extension (p <0.001) but they did not have higher rates of lymph node involvement (p = 0.85) or seminal vesicle invasion (p = 0.56). Kaplan-Meier analysis showed no significant differences in biochemical recurrence across the age cohorts (log rank 0.38). On multivariate analysis prostatectomy Gleason score, pathological stage, positive surgical margins (each p <0.001) and preoperative prostate specific antigen (p = 0.04) were independently predictive of biochemical recurrence. CONCLUSIONS We report that increased age is not associated with worse biochemical outcomes following radical prostatectomy and it should not be considered an independent prognosticator for disease recurrence. Rather, age is a surrogate for known predictors of biochemical recurrence following surgery.
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Affiliation(s)
- Ahmed Magheli
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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49
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Malaeb BS, Rashid HH, Lotan Y, Khoddami SM, Shariat SF, Sagalowsky AI, McConnell JD, Roehrborn CG, Koeneman KS. Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts. Urol Oncol 2007; 25:291-7. [PMID: 17628294 DOI: 10.1016/j.urolonc.2006.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 08/01/2006] [Accepted: 08/02/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the feasibility of radical retropubic prostatectomy (RRP) as an option for treating men older than 70 years with organ confined prostate cancer and to compare biochemical progression-free survival with younger cohorts. MATERIALS AND METHODS A total of 689 consecutive patients who were treated with RRP from 1994 to 2002 for clinically localized prostate cancer were categorized into 3 different age groups: younger than 50 years (n = 49), 50-70 years (n = 601), and older than 70 years (n = 39). Patients older than 70 years were healthy individuals for their age. Preoperative and postoperative cancer-specific characteristics were compared among these 3 groups. RESULTS There was no statistical significant difference among the 3 age strata in terms of clinical parameters (prostate-specific antigen, Gleason score, clinical stage, percent and number of positive biopsy cores) and pathologic findings (surgical margin, lymph node status, extracapsular extension, lymphovascular invasion, and pathologic Gleason score). The rate of seminal vesicle invasion and prostate volume increased with advancing age (P = 0.034 and P < 0.001). In multivariate logistic regression analysis, age was not associated with seminal vesicle invasion. The 5-year prostate-specific antigen progression-free estimates for patients younger than 50, 50-70, and older than 70 years were 82% (95% confidence interval [CI] 69% to 96%), 82% (95% CI 78% to 86%), and 65% (95% CI 43% to 86%), respectively (P = 0.349). The overall and cause-specific mortalities were not different. CONCLUSIONS RRP could be considered a standard treatment option in men older than 70 years with localized prostate cancer. Further studies are necessary to assess the survival benefit and health-related quality of life after radical prostatectomy versus watchful waiting in patients older than 70 years.
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Affiliation(s)
- Bahaa S Malaeb
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
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50
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Sun L, Moul JW, Hotaling JM, Rampersaud E, Dahm P, Robertson C, Fitzsimons N, Albala D, Polascik TJ. Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years. BJU Int 2007; 99:753-7. [PMID: 17244286 DOI: 10.1111/j.1464-410x.2006.06682.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify threshold values of prostate-specific antigen (PSA) levels and PSA velocity (PSAV) to optimize the assessment of the risk of prostate cancer in young men, as prostate cancer is detected increasingly in men aged <50 years. PATIENTS AND METHODS Data for a group of 12 078 men, including 1622 with prostate cancer, were retrieved from the Duke Prostate Center Database. Based on the latest date for a PSA assay, these men were divided into two age groups of <50 and >/= 50 years, with 904 and 11 174 men in each group, respectively. Receiver operating characteristic curves (ROC) of PSA and PSAV were calculated and the cancer risk was assessed. RESULTS The prevalence of prostate cancer was 4.4% (40 men) for men aged <50 years and 14.2% (1582 men) for men aged >/= 50 years. For the group with cancer the median PSA in men aged <50 years was significantly lower than that in men aged >/= 50 (1.3 vs 6.3 ng/mL, P < 0.001). ROC curves of PSA and PSAV showed a breakpoint at a PSA level of 2.3 ng/mL and a PSAV of 0.60 ng/mL/year for men aged <50 years. Both the sensitivity and specificity in the younger group at a PSA level of 2.5 ng/mL were higher than in the older group. CONCLUSIONS In men aged <50 years the operating characteristics of PSA are more sensitive and specific than in older men. Diagnostic PSA levels in men aged <50 years are significantly lower than suggested by guidelines. Using a 2.0-2.5 ng/mL PSA level threshold for biopsy in men aged <50 years and a PSAV threshold lower than the traditional 0.75 ng/mL/year is reasonable in contemporary practice. Further studies are warranted to validate these thresholds.
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Affiliation(s)
- Leon Sun
- Division of Urology and Duke Prostate Center, Department of Surgery, Duke University Medical, Center, Durham, NC, USA
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