Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
World J Urol. 2020 Jan;38(1):95-101. doi: 10.1007/s00345-019-02740-8. Epub 2019 Apr 2.
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.
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.
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.
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.
年龄是根治性前列腺切除术（RP）后功能和肿瘤学结果的重要预后因素。考虑到年轻患者（≤45 岁）的预期寿命较长，检查他们的结果仍然很重要。
在 2006 年 1 月至 2014 年 12 月期间，在 Martini-Klinik 前列腺癌中心接受 RP 的 16049 名患者中，有 119 名（0.7%）患者≤45 岁。根据 RP 时患者的年龄（分类为≤45、>45 和≤65、>65 岁）比较已知的预后因素。通过 Kaplan-Meier 图和 Cox 回归分析肿瘤学结果[生化无复发生存（BCR）和无转移生存（MFS）]。逻辑回归用于功能结果。尿控（UC）定义为每天使用 0 或 1 个安全垫，而勃起功能作为 IIEF-5 评分≥18。
与年龄较大的患者相比，≤45 岁的患者具有更有利的肿瘤特征。所有≤45 岁的患者中，89%接受了双侧神经保留手术，9.3%接受了单侧神经保留手术。≤45 岁患者的 5 年 BCR 无复发生存率和 MFS 分别为 80.2%和 98.7%，>45 和≤65 岁患者为 72.8%和 95.0%，>65 岁患者为 70.5%和 94.9%。对于同一组患者，1 年 UC 率分别为 97.4%、89.4%和 84.7%，而 1.3%、8.2%和 11.6%使用 1-2 个/24 小时垫。在 1 年时，75.6%、58.6%和 45.3%接受双侧神经保留手术的术前勃起功能正常患者被认为具有勃起功能。在多变量分析中，年龄较轻也是功能结果良好的独立预测因素。
≤45 岁的患者具有更有利的肿瘤特征和肿瘤学结果。此外，应告知年轻患者术后出色的控尿和勃起功能恢复率。
