Survival and oncological outcomes for young men (≤55 years) undergoing radical prostatectomy for localized prostate cancer.

OBJECTIVES

This research aimed to compare the prostate cancer (PCa) features, survival rate, and functional outcomes after open suprapubic Radical Prostatectomy (RP) between younger men (≤ 55 years) and older men (> 55 years).

METHODS

In this retrospective cohort study, we studied 134 patients with clinically localized PCa who underwent RP at our centers between 2011 and 2019, with 26 (19.40%) patients aged ≤ 55. Pathological parameters, survival rate (at 5 and 10 years), and functional outcomes such as erectile function and continence rate (at two years from RP) were evaluated retrospectively, and the two groups were compared. The Chi-square test, Kaplan-Meier, and Cox proportional hazards method were used for statistical analysis.

RESULTS

Men aged ≤ 55 had greater rates of organ-confined tumors, lower D'Amico risk grouping, and pathologic Gleason grade than their older counterparts (all p<0.05). The median follow-up was 81 months. The overall survival rate at five and ten years in younger men vs older counterparts was 96.15% vs. 93.47% and 92.15% v. 82.13% but was not statistically significant (p=0.1539). Five-year biochemical recurrence-free and metastasis-free survival rates in younger men vs older counterparts were 96.2% vs 81.5% and 75.7% vs 51.5%. Men > 55 years were associated with worse BCR-free and metastasis-free survival in univariate analysis and worsening BCR in multivariate analysis. The continence rate was significantly improved in men aged ≤ 55 years compared to older counterparts (OR: 5.08; 95% CI: 1.61-22.61; p=0.013). However, erectile function was not statistically significant between groups [for moderate ED: (OR:1.08; 95% CI: 0.43-2.79, p=0.865), for severe ED (OR: 1.60; 95% CI: 0.35-11.50, p=0.579=)].

CONCLUSIONS

Our study showed that survival rates were similar in younger men (≤ 55 years) and their older counterparts. However, older patients who underwent RP had more advanced disease, worse BCR-free survival, and worse continence rate. For localized prostate cancer patients under 55 years of age, radical prostatectomy is an excellent treatment option with excellent long-term survival results. Given the relatively small number of patients younger than 55, a large cohort study with long-term postprocedural follow-up is needed to validate this observation.