Advanced prostate cancer and the age factor

Seattle Cancer Care Alliance physicians design University of Washington-based study to examine association between age at prostate-cancer diagnosis and health outcomes
Dr. Daniel Lin
Dr. Daniel Lin of the Seattle Cancer Care Alliance is the lead author of a study that analyzed the health of younger vs. older men after diagnosis and treatment for prostate cancer. Courtesy of the University of Washington

While young men with prostate cancer have a low risk of dying early, those with advanced forms of cancer do not live as long as older men with similar forms of the disease. That is the conclusion of a study that appeared online in May ahead of publication in the July 1 print edition of CANCER, a peer-reviewed journal of the American Cancer Society. The paradoxical findings indicate that there may be biological differences between prostate cancers that develop in younger men and those that develop in older men, and that uncovering these differences may help tailor age-based screening and treatment strategies.

In general, a younger cancer patient has a better prognosis than an older patient with the same type of cancer. However, few studies have analyzed the health of younger vs. older men after diagnosis and treatment for prostate cancer.

To investigate the impact of age on prostate-cancer prognosis, Drs. Daniel Lin and Bruce Montgomery of the Seattle Cancer Care Alliance and University of Washington colleague Michael Porter designed a study at the UW to examine the association between age at diagnosis and health outcomes in men diagnosed with prostate cancer in the U.S. Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, the investigators identified 318,774 men diagnosed with prostate cancer between 1988 and 2003. Men aged 35 to 74 years were stratified by age at the time of diagnosis, and the researchers examined differences in tumor characteristics, treatment and survival within each age group.

Dr. Bruce Montgomery
Dr. Bruce Montgomery Seattle Cancer Care Alliance

The analysis revealed that, over time, men are being diagnosed with prostate cancer at younger ages, likely due to more extensive screening. Also, younger men are more likely to be treated with prostatectomy, have less aggressive cancers, and have a better chance of survival after 10 years compared with older men. However, among men with advanced prostate cancers, the youngest men (aged 35 to 44 years) have a particularly poor prognosis compared with older men. These young men are more likely to die from cancer or another cause sooner than older men with similar forms of cancer.

“These data provide support for the need to consider multimodality therapy for young men with high-risk disease and to support the ongoing neoadjuvant and adjuvant studies of systemic therapies,” said Lin, lead author.

While the reasons for this unexpected finding are not clear, the researchers suspect that young men with advanced prostate cancer may have biologically more aggressive forms of the disease than the forms that are diagnosed in older men. Additional studies are needed to determine what, if any, underlying differences exist between advanced prostate cancer found in young men vs. those found in older men. These studies may help clinicians improve screening in young men and could ultimately lead to the development of better treatment strategies for these patients.

[Adapted from a news release from the American Cancer Society.]

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