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Radical Prostatectomy in Men Younger than 50

Hardly any men -- only around 1 percent -- diagnosed with prostate cancer are younger than 50. Unfortunately, because of their age, prostate cancer is rarely even suspected; because the disease is often advanced by the time it's diagnosed, radical prostatectomy is seldom on option. (However, with increasing recognition of hereditary prostate cancer -- click here for more -- this is expected to change, as more men at high risk begin prostate cancer screening earlier, in their forties).

Mainly because of sheer lack to numbers, men younger than 50 have been something of a little-known and poorly studied quantity in the world of prostate cancer research. Is the disease more aggressive in younger men? Is it slower-growing? How do these men fare after radical prostatectomy?

Recently, several investigators, led by pathologist Jonathan I. Epstein, M.D., and Urologist-in-Chief Patrick Walsh, M.D., set out to answer some of these questions in a study of 542 radical prostatectomy patients at The Johns Hopkins Hospital. There were 85 men younger than 50 (three of them younger than 40), and 458 men aged 50 or above (the oldest was 76 years old). By far the largest study ever done of men in this age group, this analysis was also the most thorough: The researchers took into account each man's clinical stage, Gleason score, and surgical margins (in other words, they examined the edges of the tissue that was removed during surgery, and looked for the presence of cancer there); they also checked for capsular penetration, seminal vesical and lymph node involvement, and followed PSA tests for at least three years.

Their findings: Younger men who are candidates for radical prostatectomy don't have a worse prognosis after surgery than older men. In fact -- although the nerve bundles, which are responsible for erection, are more often preserved -- they fare even better.

"The operation is more successful because these men have smaller prostates," says Walsh. "There is more tissue surrounding the prostate, so the margins of resection are wider; also, the neurovascular bundles are located farther away from the prostate, and are easier to preserve. This provides a win-win: An excellent chance for cure, with improved quality of life."

Further Reading
"Radical Prostatectomy in Men Less than 50 Years Old," in Urologic Oncology, 1995, pp. 80-83. Maureen A. Riopel, Thomas J. Polascik, Alan W. Partin, Jurgita Sauvageot, Patrick C. Walsh, and Jonathan I. Epstein.


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