Prostate news article, June 2005
| DOES AGE MAKE
A DIFFERENCE IN PSA RECURRENCE AFTER RADICAL PROSTATECTOMY?
Khan FA, Kaisary AV, Boustead GB, Gillatt DA & Winkler MH. Article in: Prostate Cancer and Prostatic Diseases (2005); 8: 158-162. Reviewed by: Dr Tom Swallow BSc MBBS MRCS |
It is well known that increasing age is, unfortunately, a risk factor for prostate cancer. However there has been an increase in the incidence of prostate cancer being diagnosed in men less than 50 years of age. Likewise the median age for men undergoing radical prostatectomy over the last 20 years has dropped. The initial belief was that these men would fare worse with PSA recurrence and survival compared to their elderly counterparts. The opinion was that the tumours in these younger men were more aggressive and advanced at presentation. However there has been conflicting evidence: older patients have worse PSA-free survival rates when compared to younger patients over a 15 year follow-up period.
This study compared 682 men from 4 different urology units in the UK. These men were then analysed to identify preoperative factors associated with PSA recurrence in the first 5 years after radical prostatectomy. These factors were age, PSA, Gleason score and clinical stage. PSA recurrence was defined as two consecutive elevations above a PSA of 0.2ng/ml.
The median age of the men in the study was 64. The patients in the youngest age group (45-55 years) showed a trend to have lower PSA levels post-operatively, as well as fewer positive margins and less advanced tumours. However these results were not significant. Predictably, pre-operative PSA and Gleason score were the two factors that were strongly associated with PSA recurrence-free survival. No significant difference was found between PSA recurrence-free survival and any of the age groups.
This large multi-centre analysis offers important information for Urologists and patients. Firstly, that prostate cancer in younger men is no worse than the disease found in the older patient. Secondly, it supports the claim that there is no difference in outcome following radical prostatectomy across all age ranges. However, the median follow-up is only 48 months in this study so far and therefore these results may alter after a longer follow-up period. Previous studies have shown that older men with localised prostate cancer were being treated less often with a prostatectomy than younger patients. The authors suggest that the performance status of the patient and relative life expectancy independent of age would be of greater significance to case selection. This study also raises the question of the potential role of age specific PSA ranges.