Survival outcomes of locally advanced prostate cancer in patients aged < 50 years after local therapy in the contemporary US population.

PURPOSE: To assess survival outcomes of locally advanced prostate cancer (LAPC) in patients aged < 50 years after local therapy (LT), as compared to that in the older patients (≥ 50 years). Moreover, effectiveness of postoperative radiation therapy (PRT) after radical prostatectomy (RP) was also assessed in patients aged < 50 years.

METHODS: Within the Surveillance, Epidemiology, and End results database (2004-2014), non-metastatic cT3-4 LAPC patients treated with LT (RP, RT or RP+RT) were identified. After propensity score matching (PSM), cancer-specific mortality (CSM), overall survival (OS), and other-cause mortality (OCM) rates were assessed. Multivariable competing risk regression (MVA CRR) model was also used in our analysis.

RESULTS: 1507 younger (< 50 years) and 34833 older (≥ 50 years) LAPC patients treated with LT were identified. Younger patients with LAPC had overall more aggressive disease features than their older counterparts. After PSM, younger patients yielded higher cumulative CSM rates than the older patients (P = 0.046). However, OS and cumulative OCM rates were significantly higher (P = 0.038 and P < 0.0001, respectively) in the older cohort. In the MVA CRR model, younger patients yielded higher CSM (P = 0.02). Specifically, younger patients resulted in higher CSM in Gleason score 8-10, cT3b/4 stage, cN1 stage, and patients treated with RP. No statistically significant differences were found in patients treated with RP versus RP+PRT in all parameters.

CONCLUSIONS: LAPC patients aged < 50 years yielded higher CSM after LT, specifically after RP, compared with the older counterparts (≥ 50 years). No significant differences were observed in RP versus RP+PRT regarding survival outcomes in our analysis.