Younger men do well with prostate cancer surgery

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As a treatment for Prostate cancer in men younger than 50 years of age, surgery to remove the prostate can provide good results with low complication rates, according to a recent report.

Moreover, the findings, which appear in the journal Urology, may have a broader message as well: that men should be screened earlier for Prostate cancer, perhaps.

The study involved 790 men who underwent surgical prostate removal—prostatectomy—performed by a single surgeon over a four-year period. The patients included 66 who were younger than 50 years of age and 724 who were 50 years of age or older.

The rate of complications during the operation and after was very low, just 1.3 percent overall, and no significant differences were seen between the groups, report Dr. Herbert Lepor and colleagues from New York University School of Medicine.

The rates of urinary continence for younger and older men were 93 percent and 97 percent, respectively, the report indicates.

Among men who did not have erectile difficulties before the operation, the percentage who afterwards had erections that were adequate for intercourse (with or without the use of medical therapy) was 100 percent in the younger group compared with 81 percent in the older group.

“Current guidelines suggest that screening should begin at 50 years of age, unless you have a family history of the disease or are African American, in which case it should begin at a younger age,” Lepor told.

“However, when I reviewed the patients who were referred to me for surgery, I found that the percentage with a family history of Prostate cancer or African American ethnicity was comparable in patients over and under 50 years of age,” Lepor noted. “This suggests that many younger men were being screened who didn’t have indications for early screening” and yet they had disease that was comparable to that seen in older patients.”

Taken together, these observations led Lepor to conclude that Prostate cancer screening should begin at 40 years of age in all men. “You can’t prove that PSA screening in general (saves lives), so certainly I can’t prove that screening all men starting at 40 will be beneficial. Still, I believe that finding cancers earlier will lead to better outcomes.”

SOURCE: Urology, July 2005.

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