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Katayama N, Yorozu A, Kikuchi T, Higashide S, Masui K, Kojima S, Saito S. Biochemical outcomes and toxicities in young men with prostate cancer after permanent iodine-125 seed implantation: Prospective cohort study in 6662 patients. Brachytherapy 2023; 22:293-303. [PMID: 36599746 DOI: 10.1016/j.brachy.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We evaluated the effect of age, <60 and ≥60 years, on biochemical outcomes and toxicities in patients with prostate cancer who underwent permanent seed implantation (PI) ± external beam radiation therapy ± hormone therapy in a national Japanese prospective cohort study (J-POPS). METHODS AND MATERIALS The safety and efficacy analyses included 6721 and 6662 patients, respectively. We categorized patients into two age groups: <60 (n = 716) and ≥60 (n = 6,005) years. We used propensity score matching (PSM) to estimate the marginal effect of age on biochemical freedom from failure (bFFF) using a Phoenix definition and Cox proportional hazard models. RESULTS The median followup period was 60.0 months. Without PSM, men <60 years demonstrated similar 5-year bFFF (96.3%) compared with men ≥60 years (95.6%; p = 0.576); percent positive biopsies, biologically effective dose, Gleason score, risk classification, and supplemental external beam radiation therapy (p <0.001, <0.001, <0.001, 0.008, and <0.001) were significantly associated with bFFF while age was not (p = 0.576). With PSM, bFFF was not significantly different between age groups (p = 0.664); however, men <60 years showed a significantly lower incidence of declining erectile function, grade ≥2 all urinary toxicities, urinary frequency/urgency, and rectal bleeding (p <0.001, 0.024, 0.031, and 0.010) than men ≥60 years. CONCLUSIONS After PI, men <60 years achieved a comparable 5-year biochemical control rate and showed a lower incidence of several toxicities compared to men ≥60 years. This suggests that PI should be an excellent treatment option for men <60 years with prostate cancer.
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Affiliation(s)
- Norihisa Katayama
- Department of Radiology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takashi Kikuchi
- Translational Research Center for Medical Innovation, Kobe, Japan
| | | | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Kojima
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Shiro Saito
- Department of Urology, Ofuna Chuo Hospital, Kanagawa, Japan
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2
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Robotic-assisted radical prostatectomy in young adults: age-stratified oncological and functional outcomes. J Robot Surg 2021; 16:1057-1066. [PMID: 34813023 DOI: 10.1007/s11701-021-01334-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
There is a scarcity of information on the outcomes of robotic-assisted prostatectomy (RALP) in young men. To compare the age-stratified functional and oncological outcomes of RALP in men aged ≤ 55 years. Among 10,997 patients in our RALP series, 2243 were ≤ 55 years old. These men were divided into 3 age-stratified groups (group 1 ≤ 45 years, group 2 46-50 years, and group 3 51-55 years old). Age-stratified groups were compared for clinical, oncological, and trifecta outcomes. Kaplan-Meier curves and Cox regression models were used to identify survival estimations and their predictors. Overall, 33% and 22% of men had non-organ confined (≥ pT3) and Gleason ≥ 4 + 3 prostate cancer at final pathology, respectively. Younger patients had a higher incidence of low-risk disease and better erectile function at presentation. Organ-confined and Gleason 3 + 3 cancer rates for men ≤ 45 and 51-55 years were 82 vs. 74% and 41 vs. 30%, respectively (p < 0.05). Biochemical recurrence-free survival was similar among age-stratified groups. Bilateral full nerve-sparing (NS) rate was significantly higher in younger patients (74% in group 1 vs. 56% in group 3, p < 0.001). One-year trifecta rates were 79.8%, 71.6%, and 63.9% for increasing age groups, respectively (p < 0.001). Age, comorbidity score, and extent of NS were independent predictors of functional recovery. This study is limited by its retrospective design. At RALP, one-third of patients ≤ 55 years have locally advanced or high-risk prostate cancer. Age ≤ 45 years is associated with higher incidence of favorable tumor characteristics, which gives the surgeon increased ability to perform bilateral full NS, resulting in better functional recovery. In this report, we compared the age-stratified outcomes of RALP in a large series of men ≤ 55 years. We found that younger age was associated with more favorable tumor characteristics and better functional outcomes. We conclude that earlier diagnosis may lead to improved RALP outcomes.
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Baniak N, Sholl LM, Mata DA, D'Amico AV, Hirsch MS, Acosta AM. Clinicopathological and molecular characteristics of prostate cancer diagnosed in young men aged up to 45 years. Histopathology 2021; 78:857-870. [PMID: 33306242 DOI: 10.1111/his.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
AIMS To characterise and compare the poorly understood clinicopathological and molecular characteristics of prostatic adenocarcinoma (PCa) in very young patients. METHODS AND RESULTS We compared the clinicopathological and molecular characteristics of PCa diagnosed in 90 patients aged ≤45 years with those of PCa diagnosed in 200 patients of typical screening age (i.e. 60-65 years). Patients diagnosed at a younger age had a higher frequency of a family history of PCa and lower prostate-specific antigen (PSA) levels than those diagnosed at regular screening age. There were no statistically significant differences in clinical stage or pathological characteristics of the core biopsy specimens between the groups. Young patients had a higher frequency of Grade Group 1 disease at radical prostatectomy. A subset of 13 aggressive PCa cases from young patients underwent successful DNA-based next-generation sequencing. In all, 46.2% (6/13) had TMPRSS2 rearrangements and 23.1% (3/13) had relevant pathogenic variants in DNA damage repair genes, including a mismatch repair-deficient case with biallelic inactivation of MLH1. No statistically significant differences were observed in PCa-specific recurrence/progression between the younger and older patients, including after adjustment for clinical stage, PSA level, and Grade Group. CONCLUSIONS In this study, the clinicopathological and molecular features of PCa diagnosed in young patients were comparable to those of PCa diagnosed in patients of screening age. Early-onset PCa cases were not enriched in any of the known molecular PCa subtypes in this small series.
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Affiliation(s)
- Nicholas Baniak
- Department of Pathology, Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Molecular Pathology Division (Center for Advanced Molecular Diagnostics), Brigham and Women's Hospital, Boston, MA, USA
| | | | - Anthony V D'Amico
- Department of Radiation Oncology, Genitourinary Radiation Oncology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle S Hirsch
- Department of Pathology, Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andres M Acosta
- Department of Pathology, Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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4
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Sonmez G, Tombul ST, Demirtas T, Demirtas A. Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI-RADS 3 lesions. Asia Pac J Clin Oncol 2020; 17:e94-e99. [PMID: 32779392 DOI: 10.1111/ajco.13347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
AIM To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA) < 10 ng/mL. METHODS In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. RESULTS Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. CONCLUSION In patients with PI-RADS 3 lesion and PSA < 10 ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.
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Affiliation(s)
- Gokhan Sonmez
- Department of Urology, Erciyes University, Kayseri, Turkey
| | | | - Turev Demirtas
- Department of Medical History and Ethics, Erciyes University, Kayseri, Turkey
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Zheng Y, Lin SX, Wu S, Dahl DM, Blute ML, Zhong WD, Zhou X, Wu CL. 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. Cancer Med 2020; 9:6473-6484. [PMID: 32697048 PMCID: PMC7520296 DOI: 10.1002/cam4.3320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Yu Zheng
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei-De Zhong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xing Zhou
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Macneil J, Maclean F, Delprado W. Pathological Characteristics of Prostate Cancer Occurring in Younger Men: A Retrospective Study of Prostatectomy Patients. Urology 2019; 134:163-167. [PMID: 31541648 DOI: 10.1016/j.urology.2019.08.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/15/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To 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. METHODS A 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. RESULTS Data 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. CONCLUSION Our 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.
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Affiliation(s)
- James Macneil
- Macquarie University Faculty of Medicine and Health Science, Sydney, New South Whale, Australia; Albury Wodonga Health, Albury, New South Whale, Australia.
| | - Fiona Maclean
- Macquarie University Faculty of Medicine and Health Science, Sydney, New South Whale, Australia; Douglass Hanly Moir Pathology, Sydney, New South Whale, Australia
| | - Warick Delprado
- Macquarie University Faculty of Medicine and Health Science, Sydney, New South Whale, Australia; Douglass Hanly Moir Pathology, Sydney, New South Whale, Australia
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Roberts MJ, Papa N, Perera M, Scott S, Teloken PE, Joshi A, Vela I, Pryor D, Martin J, Woo H. A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer. BJU Int 2019; 124 Suppl 1:31-36. [DOI: 10.1111/bju.14773] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Matthew J. Roberts
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Nepean Urology Research Group; Kingswood NSW Australia
| | - Nathan Papa
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Susan Scott
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Patrick E. Teloken
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Andre Joshi
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - Ian Vela
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - David Pryor
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | | | - Henry Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
- Department of Uro-Oncology; Chris O'Brien Lifehouse; Sydney NSW Australia
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Tilki D, Maurer V, Pompe RS, Chun FK, Preisser F, Haese A, Graefen M, Huland H, Mandel P. Tumor characteristics, oncological and functional outcomes after radical prostatectomy in very young men ≤ 45 years of age. World J Urol 2019; 38:95-101. [PMID: 30937571 DOI: 10.1007/s00345-019-02740-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Age is an important prognostic factor for functional and oncological outcomes after radical prostatectomy (RP). Considering the long life-expectancy of young patients (≤ 45 years), it remains important to examine their outcomes. METHODS Of 16.049 patients who underwent RP between 01/2006 and 12/2014 at the Martini-Klinik Prostate Cancer Center, 119 (0.7%) were ≤ 45. Known prognosticators were compared according to patient age at RP (categorical as ≤ 45, > 45 and ≤ 65, > 65 years). Kaplan-Meier plots and Cox-regressions analyzed oncological outcomes [biochemical recurrence (BCR)-free survival and metastasis-free survival (MFS)]. Logistic regressions were used for functional outcome. Urinary continence (UC) was defined as the use of 0 or 1 safety pad/day and potency as an IIEF-5 score of ≥ 18. RESULTS Compared to their older counterparts, patients ≤ 45 years had more favorable tumor characteristics. Of all patients aged ≤ 45 years, 89% underwent bilateral and 9.3% unilateral nerve-sparing procedure. Five year BCR-free survival and MFS were 80.2% and 98.7% for patients ≤ 45 years, 72.8% and 95.0% for patients > 45 and ≤ 65 years and 70.5% and 94.9% for patients > 65 years. For the same groups, 1-year UC-rates were 97.4%, 89.4%, and 84.7% while 1.3%, 8.2%, and 11.6% used 1-2 pads/24 h. At 1-year, 75.6%, 58.6%, and 45.3% of preoperatively potent patients who underwent bilateral nerve-sparing were considered potent. Younger age was an independent predictor of favorable functional outcome also in multivariable analysis. CONCLUSIONS Patients aged ≤ 45 years had more favorable tumor characteristics and oncological outcomes. Moreover, younger patients should be counseled about the excellent postoperative continence and potency rates.
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Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa S Pompe
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Philipp Mandel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
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