Tumor characteristics, oncological and functional outcomes after radical prostatectomy in very young men ≤ 45 years of age

Abstract

Purpose

Age is an important prognostic factor for functional and oncological outcomes after radical prostatectomy (RP). Considering the long life-expectancy of young patients (≤ 45 years), it remains important to examine their outcomes.

Methods

Of 16.049 patients who underwent RP between 01/2006 and 12/2014 at the Martini-Klinik Prostate Cancer Center, 119 (0.7%) were ≤ 45. Known prognosticators were compared according to patient age at RP (categorical as ≤ 45, > 45 and ≤ 65, > 65 years). Kaplan–Meier plots and Cox-regressions analyzed oncological outcomes [biochemical recurrence (BCR)-free survival and metastasis-free survival (MFS)]. Logistic regressions were used for functional outcome. Urinary continence (UC) was defined as the use of 0 or 1 safety pad/day and potency as an IIEF-5 score of ≥ 18.

Results

Compared to their older counterparts, patients ≤ 45 years had more favorable tumor characteristics. Of all patients aged ≤ 45 years, 89% underwent bilateral and 9.3% unilateral nerve-sparing procedure. Five year BCR-free survival and MFS were 80.2% and 98.7% for patients ≤ 45 years, 72.8% and 95.0% for patients > 45 and ≤ 65 years and 70.5% and 94.9% for patients > 65 years. For the same groups, 1-year UC-rates were 97.4%, 89.4%, and 84.7% while 1.3%, 8.2%, and 11.6% used 1–2 pads/24 h. At 1-year, 75.6%, 58.6%, and 45.3% of preoperatively potent patients who underwent bilateral nerve-sparing were considered potent. Younger age was an independent predictor of favorable functional outcome also in multivariable analysis.

Conclusions

Patients aged ≤ 45 years had more favorable tumor characteristics and oncological outcomes. Moreover, younger patients should be counseled about the excellent postoperative continence and potency rates.

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Authors

Contributions

DT: Protocol/project development, Data collection, Manuscript writing. VM: Manuscript writing, Data analysis. RSP: Manuscript editing. FC, AH, MG, HH: Manuscript editing. PM: Protocol/project development, Data management, Data analysis, Manuscript writing.

Corresponding author

Correspondence to Philipp Mandel.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The retrospective study was approved by our institutional review-board.

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Informed consent was obtained from all individual participants included in the study.

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Tilki, D., Maurer, V., Pompe, R.S. et al. Tumor characteristics, oncological and functional outcomes after radical prostatectomy in very young men ≤ 45 years of age. World J Urol 38, 95–101 (2020). https://doi.org/10.1007/s00345-019-02740-8

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Keywords

  • Prostate cancer
  • Radical prostatectomy
  • Oncological outcome
  • Age