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

Tumor characteristics, treatments, and oncological outcomes of prostate cancer in men aged ≤60 years: real-world data from a single urological center over a 10-year period

BACKGROUND

Prostate cancer (PCa) has emerged as one of the most common malignancies among men globally. However, its pathogenesis, clinical features, and treatment responses in younger patients (aged 60 years or below) remain underexplored. This study aims to evaluate the distinctive clinical features, treatment strategies, and oncological outcomes of PCa in men aged 60 years or younger over a 10-year period at a single urological center.

METHODS

We retrospectively analyzed data from The Second Hospital of Tianjin Medical University, spanning January 2010 to June 2020. The study included patients aged ≤60 years who underwent prostate biopsies. We examined clinical characteristics, pathological findings, treatment approaches, and survival outcomes using t-tests and chi-square tests. Adjusted linear regression models evaluated the relationships between treatment modalities and outcomes, while Kaplan-Meier survival analysis and Cox regression assessed progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

RESULTS

Of the 5,686 patients who underwent prostate biopsy, 643 (11.3%) were ≤60 years old. Among these, 42.8% (275/643) were diagnosed with PCa, with 59.6% presenting at advanced stages. Compared to those with negative pathology, patients with PCa were older and more likely to have hypertension, alcohol consumption, and metabolic syndrome. Most patients (69.8%) received definitive local therapy, while 22.2% opted for palliative care and 8.0% were loss to follow-up. The median follow-up period for the entire cohort was 28.0 months and the median PFS was 77.0 months. For patients receiving definitive local therapy, the median CSS and OS were not reached, while those undergoing palliative therapy had median CSS and OS of 52.0 and 59.0 months, respectively. Multivariable analysis identified prostate-specific antigen >20 ng/mL, International Society of Urological Pathology >3, bone metastasis, and localized treatment as independent factors affecting PFS. Propensity score matching showed that definitive therapy led to superior PFS compared to palliative therapy for patients with localized PCa and a life expectancy of over 5 years.

CONCLUSIONS

Our findings highlight the influence of incidence, diagnostic characteristics, and treatment methods in younger men with PCa, emphasizing the need to identify specific risk factors and treatment response patterns. Further large-scale, multi-center research is necessary to improve diagnosis and outcomes for PCa patients in this age group.

Safety evaluation of dufulin racemate and its R(S)-enantiomers in rats based on dose-effect relationship, time-effect relationship, and lipidomics

In the present study, the dose-effect and time-effect relationships of Dufulin racemate (rac-DFL) and its R(S)-enantiomers in rats were investigated after oral administration to evaluate their safety. A total of six doses (2.5, 5.0, 10.0, 20.0, 50.0, and 100.0 mg/kg) were administered and seven time-intervals (1 h, 3 h, 1 d, 3 d, 5 d, 7 d, and 14 d) were considered to observe the effects of rac-DFL, (R)-DFL, and (S)-DFL on general behavioral characteristics, liver and kidney functions, pathological changes, and lipid metabolism in rats. The results showed that the rats in each group exhibited a good mental state, agile activity, smooth and shiny fur, and normal diet. Viscera indices of heart, liver, spleen, lung, and kidney were 5.10-5.56, 4.15-4.59, 0.24-0.28, 6.08-6.48, and 11.02-11.98 mg/g for dose-effect relationships, and 5.01-5.94, 4.11-4.79, 0.24-0.30, 6.00-6.87, and 11.02-11.99 mg/g for time-effect relationships, respectively. Values of ALT, AST, TBil, DBil, IBil, BUN, Scr, β2-MG, and UA were 33.02-38.93 U/L, 108.17-126.53 U/L, 16.22-17.94 μmol/L, 5.75-8.12 μmol/L, 9.50-10.94 μmol/L, 4.03-5.85 mmol/L, 19.42-21.61 μmol/L, 48.16-52.73 mg/L, and 68.51-78.65 μmol/L, respectively. The statistical results showed that there were no significant differences in organ indices as well as liver and kidney function indices among different groups. In terms of pathological morphology, liver and kidney tissue sections of different groups of rats demonstrated normalcy. Rac-DFL, (R)-DFL, and (S)-DFL in the range of 2.5-100.0 mg/kg exerted no significant effect on lipid metabolism. Compared with the blank group, 35, 55, and 14 differential lipids were screened from rac-DFL, (S)-DFL, and (R)-DFL groups, respectively. These lipid changes completely returned to normalcy within 3 h. There were no significant differences at 1, 3, 5, 7, and 14 d after gavage. These results will aid further evaluation of the safety of dufulin and for provision of scientific evidence for its application as a pesticide.

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

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.