Wang Y, Du S J, Zhang J X, He H Y
Department of Pathology, Peking University Shougang Hospital, Beijing 100144, China.
Zhonghua Bing Li Xue Za Zhi. 2017 Jun 8;46(6):373-377. doi: 10.3760/cma.j.issn.0529-5807.2017.06.002.
To observe the clinicopathologic features and prognosis of prostate cancer (PCa) in young men. Twenty-eight early onset (≤55 years) patients with PCa pathologically confirmed in the Peking University Third Hospital and Peking University Shougang Hospital from January 1st 2000 to August 31st 2016 were collected. There were 18 radical prostatectomy (RP) cases and 10 transrectal prostatic biopsy cases. Contemporaneously, 445 elderly (>55 years) patients were collected, of which 385 had detailed pathological information, were chosen as control group. The mean age of young group was 51 years (29-55 years). Follow-up data for 22 cases were available (1-110 months). The correlation of the clinicopathological features and prognosis were analyzed retrospectively. Presurgical prostatic specific antigen (PSA) level was abnormal in young patients, with 18 cases (64.3%) had elevated fPSA level, 26 (92.9%) had increased tPSA level, and 26 (92.9%) had decreased fPSA/tPSA ratio. Gleason score (GS) was 8 in 10.7% (3/28) of cases, and 9 in 42.9% (12/28) of cases. Of the 18 patients with RP, 17 (94.4%) had pT stage ≥pT2c. PSA level (=0.006) and GS (=0.001) were positively correlated with pT stage. Family history of PCa in 1st degree relatives was found in 9.1% of the cases. During follow-up, 2 patients died of PCa, 7 patients showed progression within 24 months. There were no significant differences in PSA level and GS between young patients and elderly patients, while the former group was more likely to have incontinence (=0.023), higher PSA levels (=0.001), and lower overall survival (=0.049). Only postsurgical PSA level was found to be negatively associated with overall survival (=0.030) and cancer specific survival (=0.021) in young patients. Presurgical PSA level and GS are positively correlated with pT stage of early onset PCa. Compared with elderly patients, young patients are more likely to have incontinence, higher postsurgical PSA level, and lower overall survival. Among all the parameters, only postsurgical PSA level shows an adverse impact on prognosis of early onset PCa. Young patients, especially those with family history, may benefit from studies on the susceptibility loci and phenotype of PCa.
观察青年男性前列腺癌（PCa）的临床病理特征及预后。收集2000年1月1日至2016年8月31日在北京大学第三医院和北京大学首钢医院经病理确诊的28例早发型（≤55岁）PCa患者。其中18例行根治性前列腺切除术（RP），10例行经直肠前列腺穿刺活检。同期收集445例老年（>55岁）患者，其中385例有详细病理资料，作为对照组。青年组平均年龄51岁（29 - 55岁）。获得22例患者的随访数据（1 - 110个月）。回顾性分析临床病理特征与预后的相关性。青年患者术前前列腺特异性抗原（PSA）水平异常，18例（64.3%）游离PSA（fPSA）水平升高，26例（92.9%）总PSA（tPSA）水平升高，26例（92.9%）fPSA/tPSA比值降低。Gleason评分（GS）8分的病例占10.7%（3/28），9分的病例占42.9%（12/28）。18例行RP的患者中，17例（94.4%）pT分期≥pT2c。PSA水平（=0.006）和GS（=0.001）与pT分期呈正相关。9.1%的病例有一级亲属PCa家族史。随访期间，2例患者死于PCa，7例患者在24个月内病情进展。青年患者与老年患者在PSA水平和GS方面无显著差异，但青年组更易出现尿失禁（=0.023）、PSA水平更高（=0.001）及总生存率更低（=0.049）。在青年患者中，仅术后PSA水平与总生存率（=0.030）和癌症特异性生存率（=0.021）呈负相关。术前PSA水平和GS与早发型PCa的pT分期呈正相关。与老年患者相比，青年患者更易出现尿失禁、术后PSA水平更高及总生存率更低。在所有参数中，仅术后PSA水平对早发型PCa的预后有不良影响。青年患者，尤其是有家族史的患者，可能会从PCa易感性位点和表型的研究中获益。
