Functional and oncological outcomes of patients aged <50 years treated with radical prostatectomy for localised prostate cancer in a European population
Menée à partir de données médicales portant sur 13 268 patients atteints d'un cancer localisé de la prostate traité entre 1992 et 2011, cette étude européenne évalue, du point de vue de la récidive biochimique, de la continence urinaire et de la préservation de la fonction érectile, l'intérêt d'une prostatectomie radicale chez les patients âgés de moins de 50 ans (443 cas)
Résumé en anglais
Objective : To address the biochemical and functional outcomes after radical prostatectomy (RP) of men aged <50 years in a large European population.
Patients and Methods : Among 13 268 patients who underwent RP for clinically localised prostate cancer at our centre (1992–2011), 443 (3.3%) men aged <50 were identified. Biochemical recurrence (BCR) and functional outcomes (International Index of Erectile Function [IIEF-5], use of pads), were prospectively evaluated and compared between men aged <50 years and older patients.
Results : Men aged <50 years were more likely to harbour D’Amico low-risk (49.4 vs 34.9%, P < 0.001), organ-confined (82.6 vs 69.4%, P < 0.001) and low-grade tumours (Gleason score <7: 33.1 vs 28.7%, P < 0.001). Multivariate Cox regression analysis showed that age <50 years (hazard ratio 0.99; confidence interval 0.72–1.31; P = 0.9) was not a predictor of BCR. Urinary continence was more favourable in younger patients, resulting in continence rates of 97.4% vs 91.6% in most recent years (2009–2011) for patients aged <50 vs ≥50 years. After RP, a median IIEF-5 drop of 4 points in younger men vs 8 points in older patients was recorded (P < 0.001). Favourable recovery of urinary continence and erectile function in patients aged <50 years compared with their older counterparts was confirmed after multivariable adjustment.
Conclusion : Men aged <50 years diagnosed with localised prostate cancer should not be discouraged from RP, as the postoperative rates of urinary incontinence and erectile dysfunction are low and probability of BCR-free survival at 2 and 5 years is high.
