Outcome after radical prostatectomy in young men with or without a family history of prostate cancer.
OBJECTIVE
To establish the cancer control afforded by radical prostatectomy in patients aged 50 years or younger with sporadic, familial, or hereditary prostate cancer.


METHODS
We collected data on all patients 50 years old or younger among 5880 patients treated for prostate cancer between 1994 and 2004. We recorded age, ethnic origin, clinical presentation, family history of prostate cancer, preoperative prostate-specific antigen (PSA) level, treatment, Gleason score, 2002 TNM stage, surgical margin status, and disease progression. Radical prostatectomy was offered as first-line treatment to all patients with localized prostate cancer (T1-T2N0M0) and negative lymph nodes. PSA-free survival was calculated.


RESULTS
We analyzed the data from 110 patients (1.9%), of whom 37 had familial cancer (33.6%) and 15 hereditary cancer (13.6%). A total of 85 patients (77.3%) had undergone radical prostatectomy, 39 (45.9%) by open retropubic surgery and 46 (54.1%) laparoscopically. The surgical margins were positive in 11 patients (12.9%). The mean follow-up after prostatectomy was 39.1 +/- 36.8 months (range 4 to 125). Nine patients (10.6%) experienced biochemical recurrence (PSA level greater than 0.2 ng/mL). Longer PSA-free survival after surgery was significantly associated with high-risk and intermediate-risk patients (P = 0.01 and P = 0.02, respectively) but not with the surgical procedure (P = 0.6) or family history of cancer (P = 0.46).


CONCLUSIONS
Radical prostatectomy is an effective treatment of localized cancer in patients younger than 50 years old. Nearly one half of our cases of prostate cancer in younger men were forms of familial cancer. Detecting familial forms is a key objective in early screening and in the timely identification of candidates for prostatectomy.
Rouprêt
Morgan
M
Department of Urology of GHU EST, Assistance-Publique Hôpitaux de Paris, University Paris VI, Paris, France. mroupret@club-internet.fr
Fromont
Gaëlle
G
Bitker
Marc-Olivier
MO
Gattegno
Bernard
B
Vallancien
Guy
G
Cussenot
Olivier
O
D000328:Adult; D020022:Genetic Predisposition to Disease; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen