Many young men with prostate-specific antigen (PSA) screen-detected prostate cancers may be candidates for active surveillance.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Little is known as to the potential for over-treatment of young men diagnosed with prostate cancer. We show that for men aged ≤55 years with PSA screen-detected disease, 45% of the tumours are classified as very low risk and 85% of these have favourable pathology, yet most are actively treated. These findings raise the spectre of over-treatment for a group of men likely to be affected by treatment side-effects.


OBJECTIVE
To identify a population of young men (aged <55 years at diagnosis) with very-low-risk prostate cancer (stage cT1c, with prostate-specific antigen [PSA] density of <0.15 ng/mL/g, Gleason score ≤6, and ≤2 positive biopsy cores with <50% tumour involvement) that may be candidates for active surveillance (AS).


METHODS
We queried a Department of Defense tumour registry and hard-copy records for servicemen diagnosed with prostate cancer from 1987 to 2010. Statistical analyses were undertaken using Fisher's exact and chi-square testing.


RESULTS
From 1987-1991 and 2007-2010, PSA screen-detected tumours diagnosed in men aged ≤55 years rose >30-fold. Data for a subset of men (174) with PSA screen-detected cancer were evaluable for disease risk assessment. Of the 174 men with screen-detected disease, 81 (47%) had very-low-risk disease. Of that group, 96% (78/81) selected treatment and, of 57 men undergoing radical prostatectomy (RP), the tumours of 49 (86%) carried favourable pathology (organ confined, <10% gland involvement, Gleason ≤6).


CONCLUSIONS
Nearly half of young men with PSA screen-detected prostate cancer are AS candidates but the overwhelming majority seek treatment. Considering that many tumours show favourable pathology at RP, there is a possibility that these patients may benefit from AS management.
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Jeri
J
Kim
James
J
Ebertowski
Matthew
M
Janiga
Jorge
J
Arzola
Gayle
G
Gillespie
Michael
M
Fountain
Douglas
D
Soderdahl
Edith
E
Canby-Hagino
Sally
S
Elsamanoudi
Jennifer
J
Gurski
John W
JW
Davis
Patricia A
PA
Parker
Douglas D
DD
Boyd
D000328:Adult; D017677:Age Distribution; D014408:Biomarkers, Tumor / Q000097:blood*; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D060787:Neoplasm Grading; D018579:Patient Selection; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000276:immunology*; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen