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

Abstract

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.