Re: Is PCa more aggressive in younger men?

[Guest guest]

Interesting take Terry and as you say non-scientific.

Let me remind you that despite the median age of diagnosis still being close

to three score and ten, whence most mortalities would be expected to

follow, we find 10% of all prostate cancer mortalities in the pre-retirement

group. [ WHO world PC stats. and it applies to most countries.]

That kind of contradicts your anecdotal. Possibly because the younger

selection of contributors at your group have more adrenaline, energy, hope,

aspiration than older men. This unfortunately does not seem to translate

into real term survival.

Having said that I agree it is important for every man to weigh up his

chances carefully before he dives into treatment that is irreversible.

Sam.

Is PCa more aggressive in younger men?

As I have travelled along this PCa journey of mine (sometimes a bit of a

rollercoaster, sometimes smooth sailing, sometimes better than I could have

imagined) one of the constantly repeated themes is that younger men

diagnosed with prostate cancer have a more aggressive form of the disease.

This is often one of the issues lurking in the background when 'younger' men

are diagnosed and are told not to consider Active Surveillance,

But how true is this? Is it another 'medical belief' ( that's what I think

of as those aspects of prostate cancer diagnosis and treatment which are not

supported by scientific data, but are practised anyhow) ? Is it a hangover

from pre-PSA testing days when it may well have been true? I had never seen

any studies that indicate that the incidence of aggressive, fast growing

cancer is greater at any specific age, but was directed to one:

J Urol. 2009 Nov;182(5):2242-8. Epub 2009 Sep 16. PMID: 19758616 Men older

than 70 years have higher risk prostate cancer and poorer survival in the

early and late prostate specific antigen eras. This concluded: Men older

than 70 years had higher risk disease and poorer survival in the early and

late prostate specific antigen eras. Pathological Gleason sums did not

change between the 2 eras. Patient age was an important variable in prostate

specific antigen screening, biopsy, treatment and prognosis.

This doesn't quite address the issue of aggressive disease in younger men,

but there is some data in this connection that I can extract from my

website, using Gleason Scores as an indicator of aggressiveness. I know that

this data has no scientific value, being entirely anecdotal, not collated by

an expert, not published etc etc, but as a broad indication, here are some

extracts from the raw information provided to me by those who contribute to

the site:

There are today 132 contributors who were under the age of 50 when they were

diagnosed (I think they would qualify as 'young'). There are only 58

contributors who were over the age of 70 when they were diagnosed - I think

they would qualify as 'old' (only for the purposes of this discussion

because I realize now that I am almost there that 70 isn't really old at

all!!).

· Of these young men, 64% had Gleason Scores of 6 or below

when diagnosed while only 33% of the older men had this score.

· 24% of the younger men had GS 7 (regrettably I cannot

distinguish between 7a (3+4) and 7b (4+3) while 38% of the older men had

this score

· 12% of the young men had GS 8 or higher while 29% of the

older men were in this category

Most of the contributions on the site are from men diagnosed in their 50s

(375 men) and their 60s (257 men). The distribution of Gleason Scores

between these two large groups does not differ substantially. 51% are GS6:

31% are GS 7: 18% are GS 8 and higher.

Of course there are other factors to take into account when estimating

aggressiveness of PCA, and, as I say, I know these are not reliable figures,

but I would be very surprised if they did not reflect the reality of the

situation. As you will see twice as many young men have a 'less aggressive'

Gleason Score of 6 than older men do. The older men on the other hand have

more than twice the number of 'aggressive' disease as indicated by the

Gleason Scores of 8 and over. I think this indicates that the view that

young men will have a more aggressive form of the disease may not be

correct and may well be a medical belief, unsubstantiated by formal study.

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in '96: and have

learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr " Snuffy " Myers : " As a physician, I am painfully aware that most

of the decisions we make with regard to prostate cancer are made with

inadequate data "