NEW YORK (Reuters Health) – Advanced prostate cancer appears to be of a more aggressive type when it occurs in young men, leading to dramatically higher cancer-specific mortality as compared with older men, according to study findings reported in the July 1 issue of Cancer.

“These data provide a strong argument for the need to consider multimodality therapy for young men with high-risk disease,” the researchers conclude.

Generally speaking, younger cancer patients have better outcomes than their older counterparts, independent of comorbidity or performance status. However, few studies have focused on survival outcomes in a wide age range of men with prostate cancer.

To fill in these gaps, Dr. Bruce Montgomery and co-authors at the University of Washington, Seattle, used the Surveillance, Epidemiology, and End Results (SEER) Program database to identify roughly 320,000 prostate cancer patients ages 35-74, “the age range during which active treatment typically is considered.”

During the 1988 through 2003 study period, the median age at diagnosis fell from 72 to 68 years old.

For those with intermediate grade disease (Gleason score 5-7), the report indicates that advancing age was associated with decreased overall survival compared with the youngest men.

“Unexpectedly,” the physicians report, “the youngest men (35-44 years of age) were at least 5 times more likely to die of prostate cancer than any of their older counterparts with high-grade, stage III disease.”

“The paradoxical effect of very young age and high-grade disease suggests that the biology of prostate cancer in young men may be inherently different and may provide new insights into the development and behavior of the disease.”

These findings make it critical, the authors conclude, to investigate systemic therapies that will improve the efficacy of local therapy, because these young men “will remain at risk for the greatest period of time.”

Reference:
Cancer 2009;115.