Treatment of Young Prostate Cancer Patients
Dear OncoLink "Ask the Experts,"
Although there are comments and cases concerning younger (under 60) prostate cancer patients, there needs to be greater focus on these patients. As you well know, with PSA and free PSA tests, more and more younger patients are being diagnosed. The decisions that a younger man must face are a shift from those of the older, more traditional prostate cancer patient. While I appreciate that cancer studies are being done concerning this age group, there is really very little help specific to these patients.
Do you have any comments?
Li Liu, MD, OncoLink Editorial Assistant, responds:
Thank you for your interest and question.
Prostate cancer is a relatively rare disease in the younger population. From birth to age 39 years the chances of men developing invasive prostate cancer are 1 in 10,000; from 40 to 59 years, 1 in 103; and from 60 to 79 years, 1 in 8 (Scardino PT, et al. Human Pathology, 1992; 23:211). Only a few studies have addressed the specific issues of young patients with prostate cancer.
Patients younger than 65 appear to have similar outcomes after radiation therapy as older patients. A report (Freedman GM, et al. International Journal of Radiation Oncology, Biology, Physics, 1996; 35:243) demonstrated that the biological disease-free survival (survival with no elevation of PSA) of patients less than 65 was not significantly different than that of patients 65 and older treated with external beam irradiation. The results are similar to those of surgical series. A small series from the University of Mississippi Medical Center (Routh A, et al. Journal of the Mississippi State Medical Association, 1997; 38:1) reported that survival appeared to be slightly better in younger age groups when patients of all stages are pooled together. However, the number was too small to make any significant conclusions.
A younger patient whose tumor is encapsulated and thus elects surgery may find comfort in knowing the prostate is removed. From a statistics stand point, in order to identify the small difference between age groups, if there is any, a large-scale study is required. However, technically this can be difficult since the prevalence of prostate cancer in the younger population is so low. To my knowledge, there is no ongoing randomized cancer study addressing the issue of age difference.