Advanced Prostate Cancer Deadlier in Younger Men

Patients under 44 were three times more likely to die, study finds

By Ed Edelson
HealthDay Reporter

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FRIDAY, May 22 (HealthDay News) -- 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."

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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."

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