Fact or Fiction on the relationship between age and agressiveness of PC

My insurance advisor made a comment the other day that went something like this "it's a known fact, in the insurance business, that the younger the age when DXed with PC the more aggressive it usually is".

Here's a paper that gives the skinny: "Treatment and survival outcomes in young men diagnosed with prostate cancer"

onlinelibrary.wiley.com/doi/10.1002/cncr.24324/full

Study said...
CONCLUSIONS:

Age at diagnosis among men with prostate cancer continued to decline. Younger men were more likely to undergo prostatectomy, have lower grade cancer, and, as a group, to have better overall and equivalent cancer-specific survival at 10 years compared with older men. Among men with high grade and locally advanced prostate cancer, the youngest men had a particularly poor prognosis compared with older men. Cancer 2009. Published 2009 by the American Cancer Society.

Age at diagnosis of cancer is a well recognized prognostic factor for patients with malignancy, and younger patients have better outcomes independent of comorbidity or performance status.1 A definition of “younger” men with prostate cancer has been poorly characterized and ranges from “<50” to “age <60 years” in previous reports.2–5 Although these divisions of younger and older men with prostate cancer have varied, previous reports typically have indicated that “younger” men have better biochemical progression-free survival after prostatectomy6, 7 and less advanced disease at prostatectomy.3 In contrast, Rosser et al reported that men aged <60 years who were treated with external-beam radiotherapy suffered higher rates of biochemical progression.4

To our knowledge, no studies have assessed the more significant endpoints of overall survival (OS) or disease-specific survival (DSS) in young men with local or regional prostate cancer, primarily because of limited follow-up and small numbers of patients in single-institution series. In clinical practice, patients usually are considered for definitive local therapy if their life expectancy is >10 years, a threshold that is crossed when men reach age 75 years.8 The objectives of the current study were to describe trends in age at diagnosis and to characterize the relation between age at diagnosis and survival outcomes in men diagnosed with prostate cancer who were considered candidates for definitive therapy based on their age. Specifically, we examined the association between age at diagnosis, tumor characteristics, and survival among men with prostate cancer in the US.

Hope that helps. Best wishes.

Nellie

It might be a known fact in the insurance business, but their facts are wrong. This is a myth. In fact even men under 40 do extremely well. Maybe it's not so much the grade of cancer in a younger person as it is the stronger immune system to keep it in check longer.

I don't know who your insurance advisor is, but I got a 20 year term life policy with a benefit of $1,000,000 2 years ago.   Just on one undectable PSA. So my company must not feel the same way.

My surgeon, who is generally very knowledgeable about current research, told me in his experience cancer tends to be more aggressive in younger guys. He said the nomograms are less predictive of outcome for guys like me because they are based on outcomes of older men. He cited that as a reason to order a bone scan even though my PSA would not typically have warranted one (although that decision was probably also influenced by my rapidly increasing PSA and one particularly scary-looking biopsy core).

In my reading, though, I can't say I agree with him on this one issue. Research seems to say outcomes are the same or better for younger men. I can't argue with my surgeon about his experience except to speculate that cancer in young men may be more likely to be found when it is symptomatic and/or palpable on a DRE than in older men. In other words, maybe we're less likely to be looking for prostate cancer in young men and therefore more likely to find only those more serious cases?

My point is that even top people in this field, who keep their skills and their knowledge current, seem to have this impression that prostate cancer is more aggressive in younger guys, but I have yet to see evidence that it is true.

I don't have any basis to "vote" on (I don't have an "opinion" on the matter, although I have an interest since I was diagnosed in my 40's)...but the research paper provided above by Riviere, above, seems to provide a pretty clear response to the question.  The paper examined both OS (overall survival; death from all possible causes) and DSS (disease-specific survival; death from prostate cancer) across age groups.

This passage was taken from the Discussion section of the paper:

The data support the intuitive concept that young men with fewer comorbidities will have better OS as a group. These data indicate that DSS at 10 years for the group as a whole is not significantly better for younger men.

So, re-stating the second sentence from the passage, the finding of this study was that PC disease-specific survival is about the same irresepective of age.

Other interesting facts are covered in the Discussion section...thanks for posting, Riviere.

 

Post Edited (Casey59) : 10/2/2012 11:55:44 AM (GMT-6)

That begs the question --- does PC start out at a particular gleason score or does a gleason 6 grow into a gleason 9....or as all things PC --- both can happen... 

so...Casey --- was I born with a gleason 9?

And in the for what it's worth category:

What Is Different about Breast Cancer in Younger Women?

Diagnosing breast cancer in younger women (under 40 years old) is more difficult, because their breast tissue is generally denser than the breast tissue in older women. By the time a lump in a younger woman's breast can be felt, the cancer often is advanced.

In addition, breast cancer in younger women may be aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer at a younger age are more likely to have a mutated (altered) BRCA1 or BRCA2 gene.

Delays in diagnosing breast cancer also are a problem. Many younger women who have breast cancer ignore the warning signs -- such as a breast lump or unusual nipple discharge -- because they believe they are too young to get breast cancer.

Many women assume they are too young to get breast cancer and tend to assume a lump is a harmless cyst or other growth. Some health care providers also dismiss breast lumps in young women as cysts and adopt a "wait and see" approach.
www.webmd.com/breast-cancer/guide/breast-cancer-young-women