Do young patients undergoing prostate cancer surgery have a worse prognosis? Oncologic outcomes in < 50 y/o prostate cancer post-radical prostatectomy

Prostate cancer (PCa) is the second most diagnosed cancer worldwide, with rising incidence in younger men due to PSA screening. The median age at diagnosis has dropped from 72 to 66 years, and PCa in men under 55 has increased ninefold. While traditionally seen in older men, autopsy and clinical studies reveal significant prevalence in younger patients, raising questions about optimal management (i.e. active surveillance). Given their long-life expectancy, understanding oncological outcomes is essential. This study aims to evaluate the oncological outcomes of PCa in patients younger than 50 years who underwent radical prostatectomy (RP) and compare these outcomes with those of patients older than 50 years. A retrospective analysis was conducted on a single-centre cohort of patients who were diagnosed with PCa and underwent RP between January 2005 and January 2019. The cohort was divided into two groups: ≤50 years and > 50 years. Biochemical recurrence-free survival (BCRFS) was the primary endpoint and overall survival (OS) was secondary. Kaplan–Meier methods and Cox regression were used. Age was analysed continuously per 10-year increase, with categorical analyses at ≤ 50 and < 55 years as sensitivity analyses. Adjusted models included PSA, clinical stage, biopsy and prostatectomy Grade Group, pathological stage, surgical margins, nodal status, and year of surgery. Out of 988 patients, 56 were ≤ 50 years old. No material between-group differences were observed in PSA, clinical stage, Grade Group, pathological stage, positive surgical margins, or nodal involvement. BCRFS was: 10/56 younger and 223/932 older patients experienced recurrence. Ten-year BCRFS was 81.3% versus 75.1% (log-rank p = 0.305). Age ≤ 50 years was not associated with BCR after adjustment (HR 0.80, 95% CI 0.39–1.63; p = 0.533), and age modelled continuously was also not associated with BCR (HR per 10 years 0.93, 95% CI 0.76–1.13; p = 0.450). Ten-year OS was 95% versus 88% (log-rank p = 0.023). Increasing age was associated with mortality (adjusted HR per 10 years 2.29, 95% CI 1.76–2.97; p < 0.001). Among patients selected for radical prostatectomy, younger age was not associated with adverse pathological features or a higher risk of biochemical recurrence. Better overall survival in younger patients should not be interpreted as evidence of a more favourable prostate cancer-specific prognosis because cause-specific mortality and comorbidity data were unavailable. Chronological age alone should not be used as a surrogate for tumour aggressiveness.