Smith C V, Bauer J J, Connelly R R, Seay T, Kane C, Foley J, Thrasher J B, Kusuda L, Moul J W
Department of Surgery, Urology Service, Walter Reed Army Medical Center, Washington, DC, USA.
J Urol. 2000 Dec;164(6):1964-7. doi: 10.1016/s0022-5347(05)66929-7.
Prostate cancer in men age 50 years or younger traditionally has accounted for approximately 1% of those diagnosed with prostate cancer. Prior studies of prostate cancer in men of this age led many clinicians to believe that they have a less favorable outcome than older men. Most of these studies were conducted before the advent of prostate specific antigen (PSA) screening programs. We evaluated a surgically treated cohort of men age 50 years or younger to determine whether disease recurred more frequently among them than in those 51 to 69 years old in the PSA era.
We reviewed the medical records of 477 men who underwent radical prostatectomy between 1988 and 1997. Age, ethnicity, preoperative PSA, clinical and pathological stage, margin and seminal vesicle involvement, and recurrence were compared between 79 men age 50 years or younger (study group) and 398, 51 to 69 years old (comparison group). Disease-free survival rates were compared using Kaplan-Meier and Cox regression techniques.
There were 6 (7.6%) recurrences in the study group (79) and 107 (26.9%) in the comparison group (398). The disease-free survival curves were significantly different (log-rank p = 0.010). Age remained a significant prognostic factor (Wald p = 0.033) in multivariate Cox regression analyses that controlled for race, clinical and pathological stage, and pretreatment PSA. Similar results were found when the comparison group was limited to 116 patients 51 to 59 years old (log-rank p = 0.034, Wald p = 0.069).
These data suggest that patients in the PSA era who underwent radical prostatectomy and were age 50 years or younger have a more favorable disease-free outcome compared to older men.
传统上，50岁及以下男性的前列腺癌约占前列腺癌确诊病例的1%。此前针对该年龄段男性前列腺癌的研究使许多临床医生认为，他们的预后不如老年男性。这些研究大多是在前列腺特异性抗原（PSA）筛查项目出现之前进行的。我们评估了一组接受手术治疗的50岁及以下男性，以确定在PSA时代，他们的疾病复发是否比51至69岁的男性更频繁。
我们回顾了1988年至1997年间接受根治性前列腺切除术的477名男性的病历。比较了79名50岁及以下男性（研究组）和398名51至69岁男性（对照组）的年龄、种族、术前PSA、临床和病理分期、切缘和精囊受累情况以及复发情况。使用Kaplan-Meier法和Cox回归技术比较无病生存率。
研究组（79人）中有6例（7.6%）复发，对照组（398人）中有107例（26.9%）复发。无病生存曲线有显著差异（对数秩检验p = 0.010）。在控制了种族、临床和病理分期以及术前PSA的多因素Cox回归分析中，年龄仍然是一个显著的预后因素（Wald检验p = 0.033）。当对照组仅限于116名51至59岁的患者时，也得到了类似的结果（对数秩检验p = 0.034，Wald检验p = 0.069）。
这些数据表明，在PSA时代，接受根治性前列腺切除术的50岁及以下患者与老年男性相比，无病预后更优。
