Advanced Prostate Cancer Deadlier in Younger Men
FRIDAY May 22, 2009 -- Younger men diagnosed with advanced prostate cancer don't live as long as older men facing the same diagnosis, a new study finds.
"Overall, young men with prostate cancer do quite well, although the young men that have more advanced prostate cancers did substantially worse than old men with similar forms of the disease," said Dr. Daniel W. Lin, lead author of a report in the July 1 issue of Cancer. "Among men with high-grade and high-stage prostate cancers, younger men are approximately three times more likely to die of prostate cancer than all other age groups."
The finding comes from an analysis of outcomes of 318,774 men listed in a national database of prostate cancer whose diagnosis was made between 1988 and 2003. That analysis also showed that over time, more American men are being diagnosed with prostate cancer at an earlier age, likely because of more intensive screening programs.
The study results add more doubts about the value of such screening programs, said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society. "Men with high-grade tumors are less likely to benefit from screening," Brawley said.
But the results drew exactly the opposite reaction from Dr. Stephen Freedland, an associate professor of urology and pathology at Duke University. "Really young men, those 35 to 44, have worse cancers," Freedland said. "This is not a group of men where we typically screen for prostate cancer. The percentage of metastatic disease is higher than for any other group. This is a failure of early diagnosis."
The finding thus lends support to the recent recommendation by the American Urological Association that men should have a first screening test for prostate-specific antigen (PSA) at age 40, Freedland said.
The lessons Lin, who is chief of urologic oncology at the University of Washington, drew from the study were not primarily about screening. "This might give some insight into prostate cancer in younger men," Lin said. "We could identify high-risk cases earlier, and thus enroll those men into clinical trials. With current treatment options limited, this is a call in part for considering clinical trials and ongoing studies of new treatments."
So for physicians treating prostate cancer, "our message is that younger men with high-grade cancers do very poorly, and when you find one, be aware that it should be treated aggressively and with experimental methods if necessary," Lin said.
PSA screening is now a major issue, with a controversy triggered by two recent reports indicating that routine screening is relatively ineffective at reducing prostate cancer deaths.
Screening recommendations by major organizations vary widely, Brawley noted, with some groups, including the American Association of Family Physicians, flatly against such programs. The American Cancer Society guidelines, which now are under review, call for a physician to discuss, but not necessarily offer, a PSA test to men with normal risk at age 50, and to high-risk men at 45.
Men at higher risk are those with a father or brother who has had the disease, and black men, who are more likely to develop prostate cancer for unknown reasons, Brawley said.
The new study supports the recommendation for earlier screening, Freedland said. "These are men that have 30 to 40 years to live, and will have the most benefit from screening," he said.
You can learn all about prostate cancer from the U.S. National Cancer Institute.
Posted: May 2009
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