Functional and oncological outcomes of patients aged <50 years treated with radical prostatectomy for localised prostate cancer in a European population
Andreas Becker*†, Pierre Tennstedt*, Jens Hansen*, Quoc-Dien Trinh†, Luis Kluth‡, Nabil Atassi*, Thorsten Schlomm*, Georg Salomon*, Alexander Haese*, Lars Budaeus*, Uwe Michl*, Hans Heinzer*, Hartwig Huland*, Markus Graefen* and Thomas Steuber*
*Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany, †Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada, and ‡Department of Urology, University-Hospital Hamburg-Eppendorf, Hamburg, Germany
• To address the biochemical and functional outcomes after radical prostatectomy (RP) of men aged <50 years in a large European population.
PATIENTS AND METHODS
• Among 13 268 patients who underwent RP for clinically localised prostate cancer at our centre (1992–2011), 443 (3.3%) men aged <50 were identified.
• Biochemical recurrence (BCR) and functional outcomes (International Index of Erectile Function [IIEF-5], use of pads), were prospectively evaluated and compared between men aged <50 years and older patients.
• Men aged <50 years were more likely to harbour D’Amico low-risk (49.4 vs 34.9%, P < 0.001), organ-confined (82.6 vs 69.4%, P < 0.001) and low-grade tumours (Gleason score <7: 33.1 vs 28.7%, P < 0.001).
• Multivariate Cox regression analysis showed that age <50 years (hazard ratio 0.99; confidence interval 0.72–1.31; P = 0.9) was not a predictor of BCR.
• Urinary continence was more favourable in younger patients, resulting in continence rates of 97.4% vs 91.6% in most recent years (2009–2011) for patients aged <50 vs ≥50 years.
• After RP, a median IIEF-5 drop of 4 points in younger men vs 8 points in older patients was recorded (P < 0.001).
• Favourable recovery of urinary continence and erectile function in patients aged <50 years compared with their older counterparts was confirmed after multivariable adjustment.
• Men aged <50 years diagnosed with localised prostate cancer should not be discouraged from RP, as the postoperative rates of urinary incontinence and erectile dysfunction are low and probability of BCR-free survival at 2 and 5 years is high.