Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
School of Medicine, Taipei Medical University, Taipei, Taiwan.
Prostate. 2021 Feb;81(2):118-126. doi: 10.1002/pros.24087. Epub 2020 Nov 5.
Prostate cancer (PCa) incidence has stabilized but not in patients at a young age. We assessed patient characteristics and disease progression in early-onset PCa.
A retrospective cohort of 28,039 newly diagnosed PCa patients aged ≥35 years was constructed using the Taiwan Cancer Registry in 2008-2016. Patients were categorized by age at diagnosis (≤54, 55-59, 60-69, 70-74, and ≥75 years). The clinical stage at diagnosis, Gleason score, prostate-specific antigen level at diagnosis, Charlson's comorbidity index, and primary and secondary treatments for PCa were included in the analysis. All-cause mortality and prostate cancer-specific mortality (PCSM) were reported. Hazard ratios (HRs) and 95% confidence intervals (CIs) estimating the risks of death and of receiving secondary cancer treatment were generated by Cox hazard models.
In patients aged ≤54, 55-59, and 60-69 years, about 60% of them in each group were classified into the high-risk, very high-risk, or metastatic group. However, young patients ≤54 years had a higher risk of PCSM than patients aged 60-69 years (HR = 1.22; 95% CI = 1.10-1.49). This trend of an increased risk in PCSM remained for high-risk, very high-risk, or metastatic patients (HR = 1.24; 95% CI = 1.01-1.51), but not in low- or intermediate-risk patients. Besides, young patients diagnosed with high-risk diseases had the highest risk of receiving secondary cancer treatment within 180 days after completing primary treatment among all age groups (HR = 1.32; 95% CI = 1.07-1.63).
PCa arising in young patients ≤54 years of age, especially those with a high risk or metastatic form, might be more aggressive than that in other age groups.
前列腺癌（PCa）的发病率虽然已经稳定，但在年轻患者中却没有稳定。我们评估了早发性 PCa 患者的特征和疾病进展情况。
使用 2008-2016 年台湾癌症登记处的数据，构建了一个 28039 例新诊断为 PCa 的年龄≥35 岁的患者回顾性队列。患者根据诊断时的年龄（≤54、55-59、60-69、70-74 和≥75 岁）进行分类。分析中包括诊断时的临床分期、Gleason 评分、诊断时的前列腺特异性抗原水平、Charlson 合并症指数以及 PCa 的主要和次要治疗方法。报告了全因死亡率和前列腺癌特异性死亡率（PCSM）。通过 Cox 风险模型生成估计死亡风险和接受二次癌症治疗风险的风险比（HR）和 95%置信区间（CI）。
在≤54、55-59 和 60-69 岁的患者中，每组约有 60%的患者被归类为高危、极高危或转移性。然而，≤54 岁的年轻患者的 PCSM 风险高于 60-69 岁的患者（HR=1.22；95%CI=1.10-1.49）。这种 PCSM 风险增加的趋势在高危、极高危或转移性患者中仍然存在（HR=1.24；95%CI=1.01-1.51），但在低危或中危患者中不存在。此外，在所有年龄组中，诊断为高危疾病的年轻患者在完成主要治疗后 180 天内接受二次癌症治疗的风险最高（HR=1.32；95%CI=1.07-1.63）。
≤54 岁的年轻患者中发生的 PCa，尤其是高危或转移性患者，可能比其他年龄组更为侵袭性。
