Is PCa more aggressive in younger men?

[Guest guest]

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 "