To determine if differences exist in the pathological characteristics of prostate cancer occurring in younger men as compared to the disease when it occurs in older men.

A retrospective cohort study was conducted on prostatectomy specimens from the prostate cancer database of a single large Australian pathology practice which services a large proportion of hospitals within one state. Data was extracted regarding the pathological characteristics of the cancers and a univariate analysis was conducted against two age cut offs.

Data was extracted for all prostatectomy specimens between 2011-2017 in 11,551 men. 132 men were 45 years old and younger, and 545 were 50 years old and younger. Statistically significant differences were found in a number of pathological characteristics. Younger men had lower Grade Group disease, and within that had less adverse pathological characteristics. In particular, even after controlling for confounding in men 45 and younger, in Grade Group 2 disease there was a lower risk of Extra Prostatic Extension (17.5% vs. 34.4%, p=0.003), and Lymph Node Involvement (0% vs. 0.8%, p=0.006), with trends toward superiority in other domains.

Our results demonstrate that prostate cancer in younger men tends to be lower grade and stage disease compared to older men. This is in contrast to persistent views within the urological community and may have an impact on disease management in younger men.

Urology. 2019 Sep 18 [Epub ahead of print]

James Macneil, Fiona Maclean, Warick Delprado

Macquarie University Faculty of Medicine and Health Science, Australia; Albury Wodonga Health, Australia. Electronic address: ., Macquarie University Faculty of Medicine and Health Science, Australia; Douglass Hanly Moir Pathology, Australia.