Prostate Cancer Survivors

 

YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

 

 

This forum is for the discussion of anything to do with Prostate Cancer.
There are only four rules:

  • No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
  • No harvesting e-mail addresses for Spam;
  • No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
  • Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making

Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.

Since this is an International Forum, please specify your location in your post.

General Forum
Start a New Topic 
Author
Comment
View Entire Thread
Re: Is PCa more aggressive in younger men?

Aloha Terry,
It seems to me that one would need a little more info to determine the degree of aggressiveness. Perhaps setting up one of those polling/question survey's with the following questions.

At time of biopsy;
PSA
PSA doubling time from initial test to biopsy
free PSA
number of PCa cores/total cores
percent PCa involvement in cores
max Gleason
Age years-months

Except for free PSA and multiple PSA tests, most men should have this data before choosing or agreeing to a treatment plan.

Now if we could just get someone to set this up ....
Joe

Re: Is PCa more aggressive in younger men?

No good looking at me to set it up Joe:-) As a matter of interest I doubt very much that the majority of men would have the data you refer to before making a treatment decision.

Of course it would be useful to collect a good deal more data, but in the absence of that, we have to make do with what we have - and since Gleason Score is the main yardstick used to measure potential aggressiveness I thought this analysis was a reasonable one to make. I think if young men were consistently diagnosed with more aggressive forms of the disease we'd see a higher number of high Gleason Scores for them.

All the best

Terry

Re: Is PCa more aggressive in younger men?

Could be two factors at work. Higher testosterone level in younger men vs older could cause their disease to progress faster, for a given initial gleason level.

And the older a man is, the greater the number of genetic defects develop in the prostate cells over time, leading to more abnormalities and
higher gleason etc.

Ben

Re: Is PCa more aggressive in younger men?

Ben,

What you theorise could be a possibility, but there is no data to support your view - at least none that I have seen.

The median age for death from PSA has not changed signficantly for many years. More than half the men who die from the disease are over the age of 80. The percentage of men who die at a relatively early age can be loosley correlated with the percentage of high grade tumours discovered in younger men.

Re: Is PCa more aggressive in younger men?

Ok Terry,
I agree, you must use what data is available. I can't help but wonder about the Gleason score. It would be almost impossible to have only one or two cores and get >=8. But if the PSA doubling time is very slow, like years, you would not know if the PCa was just found late, after most of the prostate had turned to PCa. I suspect the tumor grows in all directions at the same rate, so if confined to one or two cores, it would be a very small part of the whole prostate, and therefore <8. How much less, I don't know. My worst cores were 70%, so that would mean to me that the PCa tumor had grown at least that much perpendicular to the needle path. This would make sense in that my other cores saw less and less PCa, down to %4.
As far as determining aggressiveness you would need more info. Even high PSA does not mean aggressive, it could be BPH.
Ralph V. (the other web site) has proposed that testosterone plays a part in tumor growth. I didn't follow that reasoning.
Perhaps future studies will be able to identify that particular gene for non-aggressive & aggressive. Now it seems that if PCa returns very quickly, it is aggressive, if not ?????
Joe

Re: Is PCa more aggressive in younger men?

There seems to be a lack of clarity in my original post which I regret. I was not suggesting that young men were never diagnosed with an aggressive form of the disease. I know only too well that they are – and that those young men who are unfortunate enough to have this type of diagnosis die far too soon. The point I was trying to develop was that many young men were NOT diagnosed with aggressive forms of the disease and that, compared to, older men, there was a significantly lower number of younger men with aggressive disease.

A poster on one site suggested that a study published in July of this year might be useful. The study was Cancer. 2009 Jul 1;115(13):2863-71. Treatment and survival outcomes in young men diagnosed with prostate cancer: a Population-based Cohort Study. PMID: 19466697

There are two relevant points in the Abstract for this study (I have not had an opportunity of reading the entire document):

1. Younger men were less likely to be diagnosed with high-grade cancer, and, as a group, to have better overall and equivalent cancer-specific survival at 10 years compared with older men. The diagnostic point is what the data from my site seems to demonstrate. The site has not been running long enough to demonstrate any survival rates.

2. Among men with high grade and locally advanced prostate cancer, the youngest men had a particularly poor prognosis compared with older men. This seems in line with the Albersen paper Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 1998 Sep 16;280(11):975-80 which also found that young men with low grade disease had a better survival rate than older men with the same grade, but that the position was reversed when the disease was high grade. In those cases the young men had a poorer outcome.

I hope this helps to make clear my intention in my original post.

But I also think it is important to get the values of these percentages into focus. According to the latest figures I could find for the US (for 2005) 28,905 men died of PCa. That is an awful number to contemplate, but the total number of male deaths from all causes was said to be 1,207,675. This means that the percentage of men who died from PCa was about 2.4% of the total number of male deaths – or put another way 97.6% of the men who died, died from something other than PCa.

When we look at a breakdown of those PCa deaths we see this from the SEER statistics from 2002 – 2006:

1. The median age at death for cancer of the prostate was 80 years of age – so half the men who died were over the age of 80
2. Statistically, there were no PCa deaths of men under the age of 35
3. 0.1% of the deaths – about 29 – occurred in men aged between 35 and 44;
4. 1.4% of the deaths – about 405 – occurred in men aged between 45 and 54;
5. 7.2% of the deaths – about 2,081 – occurred in men aged between 55 and 64;
6. 20.1% of the deaths – about 5,810 – occurred in men aged between 65 and 74;
7. 40.9% of the deaths – about 11,822 – occurred in men aged between 75 and 84; and
8. 30.3% of the deaths – about 8,758 – occurred in men aged 85+ years of age.

About 9.3% ( or 17,288 men) out of the 185,895 men diagnosed with PCa were under the age of 55: about 1.5% ( or 434 men) out of the of the 28,905 who died of PCa were under the age of 55.

About 26.1% ( or 48,518 men) out of the 185,895 men diagnosed with PCa were over the age of 75: about 71.2% ( or 20,580 men) out of the of the 28,905 who died of PCa were over the age of 75.

I’m no statistician but it seems to me that more old men have aggressive forms of the disease than younger men.

RETURN TO HOME PAGE LINKS