ORLANDO — Prostate cancer was detected in almost 20% of men 45 years or younger with elevated levels of prostate-specific antigen in an Austrian study, and a substantial number of the prostate cancers in this group were significant.
Prostate cancer is rare in men younger than 45 years, with few cases reported in the literature. Therefore, little is known about the clinical and pathological features in this population.
To find out more, Dr. Wolfgang Horninger and his associates assessed 263 men aged 45 or younger enrolled in a PSA screening program in Tyrol, Austria. The men had a prostate-specific antigen (PSA) level of more than 1.25 ng/mL in combination with a free PSA of less than 18% (to increase specificity). The Tyrol Prostate-Specific Antigen Screening Project has screened more than 33,000 men of all ages to date, Dr. Horninger said. Details of the program were previously described (J. Urol. 2001;165:1143-5).
The 263 men consented to 10 systematic and 5 targeted core biopsies of their prostate. Cancer was detected in 52 men (19.8%), Dr. Horninger reported at the annual meeting of the American Urological Association. Dr. Horninger is managing medical director of the department of urology, University of Innsbruck (Austria).
Of the 48 men who opted for surgery, 31 had Gleason scores of 6 or less, whereas 17 had more advanced disease with Gleason scores of 7 or more.
In addition, 44 of the 48 men who underwent surgery had a negative digital rectal examination. The four patients with a positive result had a large variation in PSA levels: 9.7 ng/mL, 15.7 ng/mL, 17.0 ng/mL, and 40.5 ng/mL. The mean total PSA was 4.3 ng/mL and the mean free PSA was 13%.
The surgeries were either classic open retropubic prostatectomy or radical prostatectomy using the da Vinci robotic system. The mean age in the surgery patients was 43 years.
Pathology indicated 42 men had negative surgical margins. “Of the six who had a positive surgical margin, or 12.5%, all had a negative digital rectal exam and unsuspicious intraoperative palpitation,” Dr. Horninger said.
“The prostate cancer detection rate in young men with elevated PSA levels is as high as nearly 20%,” he said. “There was a substantial percentage of significant prostate cancers, even in these young patients.”
A meeting attendee asked what percentage of the total Tyrol candidate population is willing to participate in screening. Dr. Horninger estimated that 82%–83% accept the prostate cancer screening when offered.
Another attendee suggested that the 20% detection rate was partly the result of selection bias. “I agree this is a selected group of patients,” Dr. Horninger said. “What I presented here is an observation of what you can see if you screen over a long period of time.”