Abstract:
We aimed to evaluate the presenting features and
treatment outcome of prostate cancer in men aged <50 years, in
a region where prostate specific antigen (PSA) screening is not
readily available and most men present with symptoms.
Methods. We analysed the data of 1 571 men with prostatic
adenocarcinoma treated between January 1997 and December 2008
at our institution, a tertiary level public sector hospital serving a
largely indigent population. Statistical analysis was performed
using Student’s, the Mann-Whitney and Fisher’s exact tests where
appropriate (p<0.05 accepted as statistically significant).
Results. Of 1 571 men, 47 (3%) were aged <50 years. The
group aged <50 years, compared with that aged >50 years, had
a significantly greater proportion with poorly differentiated
adenocarcinoma (53%), locally advanced (stage T3 - 4) tumours (56%), haematogenous metastases (75%), significantly higher
serum PSA at diagnosis (mean 621, median 74 ng/ml) and shorter
survival.
Conclusions. Men aged <50 years presenting with symptoms
owing to prostate cancer had significantly higher-risk disease,
higher mean PSA, and poorer prognosis than men aged >50 years.
To diagnose prostate cancer at a potentially curable stage in men
aged <50 years, it is necessary to initiate baseline PSA testing at age
40 and 45 years, and to select high-risk men for PSA surveillance
in order to diagnose potentially curable cancer in those with a life
expectancy >20 - 25 years.
