Original article
Clinicopathological, functional, and immediate oncologic outcome assessment in men aged≤50 years with prostate cancer after robotic prostatectomy

https://doi.org/10.1016/j.urolonc.2016.07.016Get rights and content

Highlights

  • •

    Young men had similar pathologic findings to older men.

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    Men under and over 50 had similar continence rate after prostatectomy.

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    Erectile function was higher at all time points in younger patients.

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    There was no difference in immediate oncologic outcome between young and elder cohort.

Abstract

Background

To define the pathologic and functional outcomes of men 50 years of age and younger with prostate cancer in a contemporary robotic cohort, this study was designed.

Methods

Patients undergoing robotic-assisted laparoscopic prostatectomy from April 2002 to April 2012 (n = 2,495) formed the base population for the current analyses. The patients were dichotomized according to their age≤50 (n = 271) and>50-year-old (n = 2,224). Clinicopathological and health-related quality-of-life outcomes were recorded and analyzed for differences. Propensity score matching was used when assessing urinary and sexual function outcome.

Results

Baseline prostate-specific antigen and clinical stage were similar between men older than 50 years and those younger. Younger patients had less severe disease (D׳Amico risk and Gleason scores) and smaller prostates. Young men had higher rates of erectile function at all time points, including baseline (94% vs. 83% at 12 mo, P <0.01). Continence was similar at all time points except for 6 months, where younger patients experienced a faster return than older patients and then remained constant, while older patients continued to improve (96% vs. 89%, P<0.01). After matching process, the difference in erectile function at 6-month follow-up was lost.

Conclusion

Most men aged 50 years and younger who received robotic-assisted laparoscopic prostatectomy had clinically significant prostate cancer. Although histopathologic and short-term oncologic outcomes were nearly identical when compared to older patients, younger men had a more rapid and superior return of erectile function.

Introduction

Prostate cancer remains the most common cancer among men in the United States. Prostate cancer detection has increased over previous years. With the widespread use of prostate-specific antigen (PSA), incidence of prostate cancer increased over the previous decade, contributing to a 5.7-fold increase in the detection of prostate cancer in younger American men [1]. In Australia, the incidence of prostate cancer in the past decades has experienced a 17-fold increase in men younger than 50 years, even without a nationwide screening program [2]. Although United States Preventive Task Force has commented against the widespread use of PSA in general population as cancer screening tool due to ineffectiveness in lowering mortality, recent debates on the methodology of the interpreted data challenge the practice recommendation [3].

Early detection of prostate cancer has resulted in early treatments, and survival data suggest 98.9% 5-year survival based on 2005 to 2011 data reported by Surveillance, Epidemiology, and End Results Program [4]. Prior reports have shown differences in the pathologic features between younger and older men, but the results have been contradictory. Studies conducted before the PSA era suggested that younger patients had more aggressive tumor characteristics than older men [5], [6]. More recent analyses, however, have demonstrated that younger patients had better outcomes than a corresponding older cohort [7], [8], [9], [10]. Furthermore, men at age≤50 years presumably are healthier and have better baseline functional status than older men. As postoperative outcomes are highly correlated with preoperative functional status [11], [12], it is reasonable to expect that younger men would have improved functional outcomes following prostatectomy.

To address these issues, we reviewed the histopathologic, oncologic, and functional outcomes of a large contemporary prostatectomy database, comparing men 50 years of age or less to the remainder of the cohort.

Section snippets

Materials and methods

After institutional review board approval, we retrospectively reviewed our prospectively maintained, oncologic database for all patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) by a single surgeon between April 2002 and April 2012. Patients were dichotomized into 2 following groups according to their age at surgery:≤50 and >50-year old.

Functional outcomes and PSA were collected at baseline, 6 weeks, and then every 3 months for the first year after surgery. The

Results

Of patients undergoing RALP, 2,495 patients had clinical, demographic, and follow-up data eligible for the analyses. Of the patients eligible for the study, 271 (10.8%) were 50 years of age or younger and 2,224 were older than 50 years. In the younger cohort, prostate biopsy was performed for elevated PSA in 223 patients (82.4%), abnormal digital rectal examination in 37 (13.6%), and combined abnormal digital rectal examination and elevated PSA in 11 (4.0%).

The mean age of the younger cohort

Discussion

In this study, 271 young men (≤50 years) were studied. Young patients constituted 10.8% of our patients. In the report of an Australian study [17], only 2.6% of primary patient population were younger than 50 years, similarly a study in Germany [10] on 13,268 men diagnosed with prostate cancer, only 3.3% of men were younger than 50 years. Our data represents that 10.8% patients are younger than 50 years which is higher rate than the previously reported studies. Australian [17] and German [10]

Conclusions

In a large, single-surgeon cohort, men aged≤50 years undergoing RALP had similar pathologic outcomes as older men, with high rates of advanced grade and stage. Although the rates of continence among the 2 age groups remained similarly high postoperatively, the younger men recovered erectile function faster than their older counterparts, perhaps owing to improved overall health and baseline function. Given our relatively low number of younger patients, future studies among larger groups are

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