Adenocarcinoma of the prostate in men younger than 40 years of age: Diagnosis and treatment with emphasis on radical prostatectomy findings

Objectives. Prostate cancer is rarely diagnosed in men younger than 40 year s of age. It is thought, although not documented, that these tumors behave particularly aggressively. Methods. We studied 87 men younger than 40 years old who underwent prostate needle biopsy and were from three populations: (a) 71 cases (63 benign, 7 cancer) from Dianon Systems; (b) 9 needle biopsies with cancer sent to one of us (J.I.E.) in consultation; and (c) 7 men with cancer who came to Johns Hopkins for consultation. Results. The median age of men with a benign biopsy was 35 years (mean 33.9 , range 22 to 39); the median age of men with cancer was 38 years (mean 35. 9, range 22 to 39) (P = 0.004). The most common indications for biopsy were abnormal digital rectal examination (DRE) (n = 61), elevated prostate-spec ific antigen (PSA) (n = 14), and inflammatory symptoms (n = 12). Other reas ons cited included hematuria, abnormal ultrasound, pain, ejaculatory proble ms, obstructive symptoms, and family history of prostate cancer. The median PSA was 2.6 ng/mL (mean 4.8, range 0.3 to 66) for all men, 1.2 ng/mL (mean 3.4, range 0.3 to 19.9) for benign cases, and 4.4 ng/mL (mean 8.7, range 2 .1 to 66) for cancer (P = 0.0004). Abnormal DRE was not predictive of cance r. Of the 55 patients whose family history was known, 40 men had no family history of prostate cancer, and of those, only 6 (15%) had cancer. Of the 1 5 patients with a family history of cancer, 6 (40%) were found to have canc er on biopsy (P = 0.05). Of the 23 patients with cancer, 3 were lost to fol low-up, 1 was treated with hormones, and 3 chose watchful waiting. The rema ining 16 patients underwent radical prostatectomy and had diverse pathologi c findings. Tumor volume ranged from 0.01 to 6.35 cc. Pathologic stage was pT2 in 9 cases and pT3 in 7 cases (2 with positive pelvic lymph nodes). In 14 men, serum PSA values were available: of 4 men with PSA greater than 10 ng/mL, all had Stage pT3, and of 10 men with PSA less than 10 ng/mL, 3 had Stage pT3. Conclusions. Young men who are candidates for radical prostatectomy have po tentially curable disease, particularly if PSA at the time of diagnosis is less than 10 ng/mL. UROLOGY 53: 1179-1183, 1999. (C) 1999, Elsevier Science Inc. All rights reserved.