Prostate Cancer In Young Men Research Articles

Modern Molecular Diagnostic of Prostate Cancer in Young Men

Prostate cancer (PCa) is a public health problem. Among malignant neoplasms, it is the second most common (in 105 out of 185 countries of the world) and the main cause of death from cancer in men from 46 countries. In some cases, pathology is verified in men under 50 years of age, including at the stage of the metastatic process. Common methods of diagnosis of prostate cancer, including assessment of the PSA level, are not always accurate, and the algorithm for their use has not been finalized.

Digital Rectal Examination Is Not a Useful Screening Test for Prostate Cancer

BackgroundAnnual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance in men as young as 45 yr old has not been proved by a screening trial. ObjectiveTo determine DRE diagnostic performance in a screening trial. Design, setting, and participantsThis analysis was conducted within the multicentric, randomized PROBASE trial, which enrolled >46 000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa. Intervention(1) DRE was analyzed as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and (2) PCa detection by DRE was evaluated at the time of PSA-screen–driven biopsies (N = 578). Outcome measurements and statistical analysis(1) True-/false-positive detection rates of DRE as compared with PSA screening and (2) DRE outcome at the time of a prostate biopsy were evaluated. Results and limitations(1) A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa. Detection rate by DRE was 0.05% (three of 6537) as compared with a four-fold higher rate by PSA screening (48 of 23 301, 0.21%). The true-positive detection rate by DRE relative to screening by PSA was 0.22 (95% confidence interval [CI] = [0.07–0.72]) and the false-positive detection rate by DRE was 2.2 (95% CI = [1.50–3.17]). (2) Among PSA-screen–detected PCa cases, 86% had unsuspicious DRE (sensitivity relative to PSA was 14%), with the majority of these tumors (86%) located in the potentially accessible zones of the prostate as seen by magnetic resonance imaging. ConclusionsThe performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen–detected PCa. Patient summaryOur report demonstrated the poor diagnostic performance of digital rectal examination in the screening for prostate cancer in young men.

Digital Rectal Examination (DRE) is not useful as a solitary screening tool for prostate cancer in young men – Results from the PROBASE trial

Digital Rectal Examination (DRE) is not useful as a solitary screening tool for prostate cancer in young men – Results from the PROBASE trial

2 - Risk-adapted screening for prostate cancer in young men – First results of the PROBASE trial

2 - Risk-adapted screening for prostate cancer in young men – First results of the PROBASE trial

The Prevalence of Prostate Cancer Among Young Men Below 55Years of Age in Nigeria.

Prostate cancer is the most common cancer in men. It was initially a disease of older men above the age of 55years. Of recent, there has been reports of increase in the number of young men <55years with prostate cancer (PCa). The disease in this age group has been reported to be more lethal because of aggressive characteristics and metastatic potential. Different populations have different proportions of young-onset PCa. The aim of this study was to determine the proportion of young men aged <55years with PCa in Nigeria. Data on the prevalence of young men <55years with PCa was extracted from the 2022 report of the prevalence of cancer in Nigeria from 2009 to 2016 based on the records of 15 major Cancer Registries in Nigeria. This was a publication of the Nigerian Ministry of Health and represents the most up to date data. In 4864 men diagnosed with malignancies before age 55, PCa was the second common, following liver cancer. Out of a total of 4091 cases of PCa in all age groups, 355 were diagnosed in men <55years representing 8.86%. Furthermore, the proportion of young men with the disease in the Northern part of the country was 11.72%, whereas in the South, it was 7.77%. PCa is the second most common cancer in young Nigerian men aged< 55years preceded by liver cancer. The proportion of young men with PCa was 8.86%. It is therefore important to consider PCa in young men as a different entity and develop appropriate ways to control this disease to ensure survival and good quality of life.

Opportunities for early detection of prostate cancer in young and middle-aged men

Prostate cancer (PCa) is a public health problem worldwide. Among all malignant tumors, PCa ranks second in prevalence (105 out of 185 countries) and fifth in cause of death in men in 46 countries. In some cases, this pathology is verified in men under the age of 50, including the advanced stage of the metastatic process. The review article provides information on the epidemiology and prevalence of PCa in young men obtained from the PubMed, CrossRef, and Scopus databases. The data on the probable causal relationship of a number of factors potentially affecting the development of prostate carcinoma are presented. Little-known and new molecular genetic changes are described, including those associated with prostate-specific antigen (PSA), with a proven role in the development of this disease, the use of which will make it possible to predict PCa development in the early stages in a timely manner. It has been determined that the common methods for diagnosing carcinoma in the population, assessing the level of serum PSA, are not always accurate and that the algorithm for their use has not been finally formed. The study of risk factors for the development of PCa in young patients will make it possible to formulate a new diagnostic approach based on considering personal molecular genetic information. The development of this direction is relevant and has an important social and economic importance, considering the study of the contingent of the able-bodied population.

A randomized trial of risk-adapted screening for prostate cancer in young men-Results of the first screening round of the PROBASE trial.

There is no generally accepted screening strategy for prostate cancer (PCa). From February 2014 to December 2019 a randomized trial (PROBASE) recruited 46 642 men at age 45 to determine the efficacy of risk-adapted prostate-specific antigen-based (PSA) screening, starting at either 45 or 50 years. PSA tests are used to classify participants into a low (<1.5ng/mL), intermediate (1.5-2.99 ng/mL) or high (≥3ng/mL) risk group. In cases of confirmed PSA values ≥3ng/mL participants are recommended a prostate biopsy with multiparametric magnetic resonance imaging (mpMRI). Half of the participants (N=23 341) were offered PSA screening immediately at age 45; the other half (N=23 301) were offered digital rectal examination (DRE) with delayed PSA screening at age 50. Of 23 301 participants who accepted baseline PSA testing in the immediate screening arm, 89.2% fell into the low, 9.3% into intermediate, and 1.5% (N=344) into the high risk group. Repeat PSA measurement confirmed high-risk status for 186 men (0.8%), of whom 120 (64.5%) underwent a biopsy. A total of 48 PCas was detected (overall prevalence 0.2%), of which 15 had International Society of Uropathology (ISUP) grade 1, 29 had ISUP 2 and only 4 had ISUP ≥3 cancers. In the delayed screening arm, 23 194 participants were enrolled and 6537 underwent a DRE with 57 suspicious findings, two of which showed PCa (both ISUP 1; detection rate 0.03%). In conclusion, the prevalence of screen-detected aggressive (ISUP ≥3) PCa in 45-year-old men is very low. DRE did not turn out effective for early detection of PCa.

Causation of increased prostate cancer in young men.

Causation of increased prostate cancer in young men.

Prostate cancer in young men represents a distinct clinical phenotype: gene expression signature to predict early metastases.

Aim:Several genomic signatures are available to predict Prostate Cancer (CaP) outcomes based on gene expression in prostate tissue. However, no signature was tailored to predict aggressive CaP in younger men. We attempted to develop a gene signature to predict the development of metastatic CaP in young men.Methods:We measured genome-wide gene expression for 119 tumor and matched benign tissues from prostatectomies of men diagnosed at ≤ 50 years and > 70 years and identified age-related differentially expressed genes (DEGs) for tissue type and Gleason score. Age-related DEGs were selected using the improved Prediction Analysis of Microarray method (iPAM) to construct and validate a classifier to predict metastasis using gene expression data from 1,232 prostatectomies. Accuracy in predicting early metastasis was quantified by the area under the curve (AUC) of receiver operating characteristic (ROC), and abundance of immune cells in the tissue microenvironment was estimated using gene expression data.Results:Thirty-six age-related DEGs were selected for the iPAM classifier. The AUC of five-year survival ROC for the iPAM classifier was 0.87 (95%CI: 0.78–0.94) in young (≤ 55 years), 0.82 (95%CI: 0.76–0.88) in middle-aged (56–70 years), and 0.69 (95%CI: 0.55–0.69) in old (> 70 years) patients. Metastasis-associated immune responses in the tumor microenvironment were more pronounced in young and middle-aged patients than in old ones, potentially explaining the difference in accuracy of prediction among the groups.Conclusion:We developed a genomic classifier with high precision to predict early metastasis for younger CaP patients and identified age-related differences in immune response to metastasis development.

Survival outcomes of Asian younger men (< 55years) undergoing radical prostatectomy: a review of prostate cancer database in a tertiary hospital in Singapore.

Prostate cancer largely affects older men. This study aims to investigate prostate cancer in younger men (< 55years) to shed light on the survival outcomes of this unique subset of patients in Asian context. 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. A total of 1120 men underwent radical prostatectomy between 1998 and 2016. Of these, 12 were aged ≤ 44years, 106 were aged 45-54years, 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). This large cohort of Asian patients who underwent radical prostatectomy did not show significant age-related differences in important parameters and outcomes.

Prostate cancer in young men: An emerging young adult and older adolescent challenge.

Recent observations suggest that prostate cancer is an increasing disease among older adolescents and young adults. Incidence, mortality, and survival data were obtained from the US National Cancer Institute Surveillance, Epidemiology, and End Results program and the Institute for Health Metrics and Evaluation Global Burden of Disease database. Worldwide, the incidence of prostate cancer has increased in all groups between ages 15 and 40years and increased globally at a steady rate averaging 2% per year since 1990 (P<.01). In the United States, this age group was >6 times more likely than older men to have distant disease at diagnosis. Stage for stage, their survival rate improved less than in older men. Whereas the overall 5-year relative survival rate in the United States for men diagnosed between ages 40 and 80years was between 95% and 100%, it was 30% in those aged 15 to 24years, 50% in those aged 20 to 29years, and 80% in those aged 25 to 34years. Prostate cancer in older adolescent and young adult men has increased in most countries. There is some evidence that this may be caused in part by underdiagnosis, prostate-specific antigen screening, and overdiagnosis. It also may be caused by trends in obesity, physical inactivity, HPV infection, substance exposure, environmental carcinogens, and/or referral patterns. How the biology of these cancers differs from that in older men and how the etiologies vary from country to country remain to be determined.

Pathological Characteristics of Prostate Cancer Occurring in Younger Men: A Retrospective Study of Prostatectomy Patients

ObjectiveTo determine if differences exist in the pathological characteristics of prostate cancer occurring in younger men as compared to the disease when it occurs in older men. MethodsA retrospective cohort study was conducted on prostatectomy specimens from the prostate cancer database of a single large Australian pathology practice which services a large proportion of hospitals within 1 state. Data were extracted regarding the pathological characteristics of the cancers and a univariate analysis was conducted against 2 age cutoffs. ResultsData were extracted for all prostatectomy specimens between 2011 and 2017 in 11,551 men. One hundred and thirty-two men were 45 years old and younger, and 545 were 50 years old and younger. Statistically significant differences were found in a number of pathological characteristics. Younger men had lower grade group disease, and within that had less adverse pathological characteristics. In particular, even after controlling for confounding in men 45 and younger, in Grade Group 2 disease there was a lower risk of extra prostatic extension (17.5% vs 34.4%, P = .003), and lymph node involvement (0% vs 0.8%, P = .006), with trends toward superiority in other domains. ConclusionOur results demonstrate that prostate cancer in younger men tends to be lower grade and stage disease compared to older men. This is in contrast to persistent views within the urological community and may have an impact on disease management in younger men.

Prostate cancer in young men: Our experience.

133 Background: Prostate cancer (PCa) diagnosis is not uncommon in younger men. The three recognized risk factors for PCa are increasing age, african-american race and a family history (FH). Data about PCa treatment outcomes are controversial, younger men may have more aggressive disease and worse prognosis. On the other hand, more recent studies suggest higher rates of indolent PCa with more favorable outcomes in young men after radical prostatectomy (RP). We aimed to compare younger (G1, ≤ 55 yo) vs. older adults (G2, &gt; 56 yo) who underwent RP for PCa between 2010-2016 in terms of FH, race and tumor aggressiveness. Secondly, to determine if the PCa in G1 is more aggressive when there is a PCa familiar background. Methods: Between 2010-2016, 419 men underwent RP for clinically localized PCa at Central Lisbon Hospitals, of which 49 were aged ≤55 years at the time of RP. Clinical characteristics such as race, FH, PSA level, clinical stage, and biopsy Gleason score (BGS) were recorded before RP. Pathological parameters (pathological stage, GS and PSA) were collected after surgery. Results: In G1, 31% had PCa FH vs. 10% in G2 (p &lt; 0.001). Before RP, the average PSA in G1 was 7.47 vs. 8.08 in G2 (p = 0.371). In BGS, 44,3% had Gleason (G) 6, 37,4% G7, 6.9% G≥8, not significantly different between both groups (p = 0.651). Albeit, G1 had more aggressive tumors after RP: 27% G6, 45% G7 e 29% G≥8 vs. 37%, 53% e 11% respectively in G2 (p = 0.002). The pathological stage (pT) was not significantly different between groups (p = 0.243). Biochemical recurrence (BCR) was higher in G1 20% vs. 9% (p = 0.010). In a multivariate logistic regression model, the G1 had more BCR (p = 0.047) and higher PCa FH incidence (p = 0.002). When comparing african vs. caucasian men, the first group had more aggressive tumor histology (p = 0.021). Conclusions: Our study demonstrated that the youngest had superior pathological grades with higher BCR rates. Also, we found a strong relationship between G1 and FH of PCa. Data regarding pathological findings after RP in young men are still controversial. Recent studies confirm that pathological PCa characteristics in young men are not more aggressive than in older men. The present intends to add to the scientific debate around the impact of patients’ age in PCa aggressiveness and prognosis.

Evaluation of Cancer-Specific Mortality with Surgery Versus Radiation as Primary Therapy for Localized High-Grade Prostate Cancer in Men Younger than 60 Years Old

PurposeThe optimal primary treatment for localized high-grade prostate cancer in younger men remains controversial. The objective of this project was to compare the impact of initial radical prostatectomy versus radiation therapy on survival outcomes for young men <60 years old with high-grade prostate cancer. Materials and MethodsWe retrospectively analyzed the records of men under 60 years old in the Surveillance, Epidemiology, and End Results (SEER) database who underwent initial surgery or radiation therapy for high-grade (Gleason score ≥ 8) localized (N0M0 TNM stage) prostate cancer from 2004-2012. Univariate and Multivariate Cox proportional hazards regression models were used to examine prostate cancer-specific and overall mortality. ResultsA total of 2,228 men were identified. 1,459 men (65.5%) underwent initial surgery and had a median follow-up of 43 months. 769 men (34.5%) underwent initial external beam radiation therapy ± brachytherapy and had a median follow-up of 44 months. On multivariate analysis, initial treatment with surgery was associated with improvement in prostate cancer-specific mortality and overall mortality compared with initial treatment with radiation (HR 0.37; 95% CI 0.19 – 0.74; p = 0.005 and HR 0.41; 95% CI 0.24 – 0.70; p = 0.001 respectively) when controlling for age, biopsy Gleason score, T stage, and PSA. ConclusionsOur data show significant survival differences in young men treated initially with surgery versus external beam radiation therapy for high-grade prostate cancer. Future prospective randomized trials are needed to confirm long-term outcomes of these treatment approaches.

Long-term outcomes following proton therapy for prostate cancer in young men with a focus on sexual health

Background: We investigated long-term outcomes for men ≤60 years old treated with proton therapy (PT).Methods: Of 254 men ≤60 years old were treated with proton therapy alone for prostate cancer. Risk stratification included 56% with low-, 42% with intermediate- and 2% with high-risk disease. Patients received 76–82 Gy at 2 Gy/fraction or 70–72.5 Gy at 2.5 Gy/fraction. Before treatment and every 6–12 months for 5 years, patients were evaluated by a physician, answered health-related quality of life surveys, including the EPIC, IIEF and IPSS, and had PSA evaluated.Results: Median follow-up for the cohort was 7.1 years; 7-year biochemical-free survival was 97.8%. Eight men (one high-risk; five intermediate-risk and two low-risk) experienced biochemical progression, including one who died of disease 9 years after treatment. Potency (erections firm enough for sexual intercourse) was 90% at baseline and declined to 72% at the first-year follow-up, but declined to only 67% at 5 years. Only 2% of patients developed urinary incontinence requiring pads. The bowel habits mean score declined from a baseline of 96 to 88 at 1 year, which improved over the following years to 93 at 5 years.Conclusions: Young men with prostate cancer continue to have excellent results with respect to 7-year biochemical control and 5-year erectile function, without clinically significant urinary incontinence 5 years after proton therapy. Comparative effectiveness studies of proton therapy with surgery and IMRT are needed.

Increasing detection of significant prostate cancer in younger men - ten year trends in prostate cancer risk profile in the Mid-West of Ireland.

IntroductionAlthough PSA (prostate specific antigen) based screening for prostate cancer (PCa) is controversial, an increasing number of men are undergoing Transrectal Ultrasound Guided prostate biopsy (TRUSPB) through primary care-based PSA testing and referral to hospitals. The aim of our study was to investigate presenting risk profiles of PCa over the last decade in a cohort of men in Ireland and to examine any change in the same over this time period.Material and methodsThe hospital patient administration system was analysed for patients who underwent TRUSPB from January 2005 to December 2015. Clinically significant PCa was defined as Gleason score of 7 or above.ResultsComplete data was available on 2391 TRUSPB patients: number of biopsies increased by 53%, median age decreased by 0.9%, median PSA decreased by 6% (p = 0.001, ANOVA) and abnormal DRE increased by 9% (p = 0.001, chi square). Overall positive biopsy was 44% and significant cancer rate was 21%. There was a significant change in trend of detection (p = 0.02) with average annual increase in significant cancer of 3%. The median age of the significant cancer cohort reduced by 1% and the PSA at diagnosis reduced by 9%. In younger men (<50 years), the rate of significant cancer detection increased by 18%.ConclusionsSignificant PCa detection increased across all age groups but recently, a younger patient profile was diagnosed with high-grade disease. This paves the way for future research on early-onset PCa. Younger patients with significant disease would result in increasing number of patients being eligible for radical treatment with implications on health resource planning and provision.

Gene Expression Differences in Prostate Cancers between Young and Old Men

Prostate cancer incidence is increasing in younger men. We investigated whether men diagnosed with Gleason 7 (3+4) T2 prostate cancer at younger ages (≤ 45 years, young cohort) had different mRNA and miRNA expression profiles than men diagnosed at older ages (71–74 years, older cohort). We identified differentially expressed genes (DEGs) related to tumor-normal differences between the cohorts. Subsequent pathway analysis of DEGs revealed that the young cohort had significantly more pronounced inflammatory and immune responses to tumor development compared to the older cohort. Further supporting a role of inflammation-induced immune-suppression in the development of early-onset prostate cancer, we observed significant up-regulation of CTLA4 and IDO1/TDO2 pathways in tumors of the young cohort. Moreover, over-expression of CTLA4 and IDO1 was significantly associated with biochemical recurrence. Our results provide clues on the mechanisms of tumor development and point to potential biomarkers for early detection and treatment for prostate cancer in young men.

Abstract 3435: Prostate cancer in WTC respondents

Abstract Background: Ten years following the 9/11/2001 attacks on the World Trade Center (WTC), an increased incidence of prostate cancer was reported in two separate cohorts of WTC rescue and recovery workers. Whether this increase is due to WTC-related exposures or increased surveillance is uncertain. Methods: Prostate cancer cases and Gleason scores diagnosed after 9/11 from 2002 to 2014 were obtained from the WTC Health Program (n = 180). Differences in proportions of Gleason scores 7+ (moderate to high-grade cancer) in WTC respondents and New York State were calculated based on the NYS Cancer Registry (NYSCR). An age-adjusted rate for Gleason scores of ≥7 was calculated using the indirect method based on NYSCR. Age- and race-matched prostate cancer non-WTC respondent controls (n = 253) were obtained from Mount Sinai Hospital. We evaluated the effects of WTC-respondent status, exposure level, age, race, prostate-specific antigen (PSA) concentrations, and clinical stage on Gleason scores using log-linear regression. WTC exposure was analyzed by four categorical levels and continuously using a relative rank of potential carcinogen-related post-9/11 exposures. Differences in mean numbers of PSA screening visits were assessed using Student's t-test. Results: The age-adjusted rate for a Gleason score ≥7 was 1.15 for WTC respondents (95% Confidence Interval (CI): 0.94, 1.36) compared to the NYSCR. WTC respondents &amp;lt; 40 years old had an 8-time higher proportion of aggressive cancers than expected based on NYSCR age-specific rates. The proportion of Gleason scores ≥7 was 0.33 (95% CI: -0.06, 0.12) higher in WTC respondents than NYSCR. WTC respondents had lower Gleason scores (Odds Ratio (OR): 0.90 (95% CI: 0.82, 0.99)), PSA values (OR: 0.79; 95% CI: 0.71, 0.89), but higher clinical stage (OR: 1.04; 95% CI: 0.92, 1.16) than controls. When Gleason score was adjusted for PSA and clinical stage, the OR for PSA testing was 1.04; 95% CI: 0.88, 1.23 and clinical stage was lower (OR: 0.82; 95% CI: 0.69, 0.98) in WTC-respondent cases. The mean numbers of PSA-screening visits were not different between WTC respondents and controls (t = 0.64; P = 0.52) and were not associated with Gleason scores ≥7 (OR: 1.0; 95% CI: 0.88, 1.13). Four-level exposure categories (OR: 0.99; 95% CI: 0.99, 1.00) and continuous rank (OR: 0.88; 95% CI: 0.73, 1.06) showed no associations with Gleason scores. Days spent at WTC (OR: 1.00; 95% CI: 1.00, 1.03) and working on the WTC debris pile (OR: 0.95; 95% CI: 0.86, 1.05) showed similar results. Conclusions: Young WTC respondents had higher Gleason scores than the NYSCR. Number of PSA screening visits did not significantly differ between WTC respondents and controls and PSA values of WTC respondents were lower than controls. Aggressive prostate cancer was not associated with WTC exposure levels. Considering the high grade of prostate cancer in younger men and the long latency for prostate cancer development, continued monitoring is needed to determine alternative causes of elevated prostate cancer in the WTC population. Citation Format: Dana Hashim, Paolo Boffetta, William Oh, Sylvain Wallenstein, Matthew Galsky, Emanuela Taioli. Prostate cancer in WTC respondents. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3435.

Clinical performance of serum isoform [‐2]proPSA (p2PSA), and its derivatives %p2PSA and the Prostate Health Index, in men aged &lt;60 years: results from a multicentric European study

To test the hypothesis that [-2]proPSA (p2PSA) and its derivatives are more accurate than total prostate-specific antigen (tPSA), free prostate-specific antigen (fPSA) and fPSA as percentage of tPSA (%fPSA) in detecting prostate cancer (PCa) in men aged <60 years. The analysis consisted of a nested case-control study from the PRO- PSA Multicentric European Study (PROMEtheuS) project. The primary outcomes were measures of sensibility, specificity and accuracy of serum p2PSA, p2PSA as percentage of fPSA (%p2PSA) and Beckman Coulter prostate health index (PHI) in men aged <60 years who had undergone a prostate biopsy. The potential reduction in the number of unnecessary biopsies and the characteristics of the potentially missed PCa cases were reported as secondary outcomes. Multivariate logistic regression models were complemented by predictive accuracy and decision-curve analyses. Of the 1036 patients enrolled in the PROMEtheus project, 238 (22.9%) were aged < 60 years. PCa was found in 67 subjects (28.1%); p2PSA, %p2PSA and PHI values were significantly higher (P < 0.001) among these subjects, while no differences were found in tPSA, fPSA and %fPSA values. On univariate analysis, %p2PSA (area under the curve [AUC]: 0.704) and PHI (AUC: 0.7) were the most accurate predictors, and these significantly outperformed tPSA (AUC: 0.549), fPSA (AUC: 0.511) and %fPSA (AUC: 0.557) in the prediction of PCa at biopsy (P ≤ 0.001). In multivariate logistic regression models, %p2PSA and PHI achieved independent predictor status and significantly increased the accuracy of multivariate models by 6.3 and 7.6%, respectively (P ≤ 0.05). PHI and %p2PSA are more accurate than the reference standard tests in predicting PCa in young men.

Clinical analysis of prostate cancer in young men under 50 years

Objective To analyze the clinical features of patients with prostate adenocarcinoma under 50 years.Methods Between January 2008 and April 2014,we reviewed 21 cases with prostate cancer under 50 years old.The mean age in those patients was 48 years old (ranged 42-49 years old).Their tPSA level was elevated,including＞10 μg/L in 17 cases,4-10 μg/L in 4 cases.21 cases were all confirmed by pathology.The results Gleason score showed 6 scores in 3 cases,7 scores in 6 cases (3+4 scores in 5 cases and 4+3 scores in one case),8 scores in 7 cases and 9 scores in 5 cases.In the study,clinical stage was for T2N0M0 in 16 cases,T3N0M0 in 1 case,T4NxM0 in 1 case and T3-4N1M1 in 3 cases.The treatments were hormonal therapy was chosen in 5 cases and radical prostatectomy was performed in 16 cases,including 16 cases with T2N0M0 stage and one case with T3N0M0.Results In those patients who accepted the radical prostatectomy,the duration of follow-up ranged from 3 to 65 months (mean 23 months).During the follow-up,14 patients had a lower incidence of biochemical recurrence.1 patient (T2,PSA 82.8 μg/L,GS 9) had external beam radiotherapy one month after the radical prostatectomy because of tumor invasion into the prostatic capsule.Then his PSA level returned to the 0.2 μg/L.1 patient (T3,PSA 38.9 μg/L,GS 8) had external beam radiotherapy 18 months after the radical prostatectomy because of biochemical recurrence and the tPSA level returned to the 4.0 μg/L.All patients who underwent radical prostatectomy had favourable recovery of urinary continence.In 5 patients who had androgen deprivation therapy,2 patients died after 63 or 65 months and one patient was lost to follow-up.The PSA level in one patient decreased from 71.8 μg/L to 2 μg/L after four months treatment.One patient had castration resistant prostate cancer and the adjuvant external beam radiotherapy was considered,subsequently.Conclusions Men under the 50 years old,who are diagnosed with localised prostate cancer,usually demonstrated the early clinic stage and high Gleason scores.It should not be discouraged from RP.Young men with metastatic prostate cancer have a poor prognosis. Key words: Prostatic neoplasms; Therapy; Prognosis; Age