Cancer-specific mortality in men diagnosed with prostate cancer before age 50 years, a nationwide population-based study

To compare the clinical characteristics and cancer-specific mortality in men diagnosed with prostate cancer before versus after age 50 years.

919 men aged 35 to 49 years and 45,098 men aged 50 to 66 years, diagnosed with prostate cancer between 1998 and 2012, were identified in Prostate Cancer data Base Sweden (PCBaSe). Cancer-specific mortality was compared between age groups 35 to 49, 50 to 59, 60 to 63 and 64 to 66 years, with and without adjusting for cancer characteristics, comorbidity and education in a multivariable Cox proportional hazards model.

Clinical cancer characteristics indicated that most non-metastatic cancers in men younger than 50 years were detected after prostate-specific antigen testing. The proportions of non-metastatic versus metastatic disease at diagnosis were similar in all age groups. A strong association between younger age and poor prognosis was apparent for men with metastatic disease diagnosed before age 50 to 55 years. The crude and adjusted hazard ratios of cancer-specific mortality were 1.41 and 1.28 (95% confidence intervals 1.12-1.79 and 1.01-1.62) for men diagnosed before age 50 compared with men diagnosed at age 50 to 59. Among men with non-metastatic disease, the crude cancer-specific mortality increased with older age, but the adjusted cancer-specific mortality was similar in all age groups.

Our findings suggest that an aggressive form of metastatic prostate cancer is particularly common in men younger than 50 to 55 years of age. Genetic studies and trials of intensified systemic treatment in this patient group are warranted.

The Journal of urology. 2016 Jun 17 [Epub ahead of print]

Andreas Thorstenson, Hans Garmo, Jan Adolfsson, Ola Bratt

Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm; Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom., King´s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom; Regional Cancer Centre, Uppsala Örebro, Uppsala, Sweden., Department of Clinical Sciences, Interventions and Technology, Karolinska Institute, Stockholm, Sweden., Department of Translational Medicine, Division of Urological Cancer, Lund University, Sweden; CamPARI Clinic, Department of Urology, Cambridge University Hospitals, Cambridge, United Kingdom. Electronic address: .