As a treatment for prostate cancer in men younger than 50 years, radical retropubic prostatectomy can provide good results with low complication rates, according to a recent report.
However, the findings, which appear in the July issue of Urology, may have a broader message as well: men should be screened earlier for prostate cancer. The study involved 790 men who underwent open radical retropubic prostatectomy performed by a single surgeon between October 1, 2000 and December 31, 2003. The patients included 66 who were younger than 50 years of age and 724 who were 50 years of age or older.The two age groups were comparable in terms of pathologic stage, percentage of cancer in the surgical specimen, positive surgical margin rate, and Gleason score, senior author Dr. Herbert Lepor and colleagues, from New York University School of Medicine, note. Moreover, about one third of men in each group had risk factors for prostate cancer.The combined intraoperative and postoperative complication rate was very low, just 1.3% overall, and no significant differences were seen between the groups.The rates of urinary continence for younger and older men were 93.3% and 97.1%, respectively, the report indicates (p=NS). Among potent men, the percentage having erections that were adequate for intercourse after surgery, with or without the use of medical therapy, was 100% in the younger group compared with 81.4% in the older group (p = 0.02).”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,” Dr. Lepor told Reuters Health.”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,” Dr. 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 Dr. 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 2005;66:141-146: Reuters Health: Anthony J. Brown, MD: Oncolink: August 2005.)