Does age matter in the selection of treatment for men with early-stage prostate cancer?

BACKGROUND. The specific aim of the current study was to compare freedom from biochemical failure, distant metastases-free survival, and overall survival in men age ≤55 years, men ages 60 to 69 years, and men age ≥70 years presenting with localized prostate cancer. METHODS. A matched pair analysis compared patients age ≤55 years (Group 1) who were treated with 3-dimension conformal radiation without androgen deprivation to men age ≥60 years and <70 years (Group 2), and men age ≥70 years (Group 3) who were treated at the Fox Chase Cancer Center between November 1989 and October 2001. The groups were matched for disease stage (T1/T2b vs. T2C/T3), Gleason grade (2-6 vs. 7-10), radiation dose (<70 Gray [Gy] vs. ≥70-76 Gy vs. ≥76 Gy), and pretreatment prostate-specific antigen (PSA) level. Estimates of outcome were accomplished using Kaplan-Meier methodology and compared by age group using the log-rank test. RESULTS. Eighty-four men were identified according to the selection criteria. No statistically significant difference was found in the 5-year overall survival rates for Group 1, Group 2, and Group 3 (94%, 95%, and 87%, respectively) or the 5-year rate of freedom from biochemical failure in Group 1, Group 2, and Group 3 (82%, 76%, and 70%, respectively), or freedom from distant metastases (96%, 97%, and 98%, respectively). CONCLUSIONS. Men age ≤55 years who present with localized prostate cancer do not appear to have a worse prognosis. External beam radiation therapy appears to be a viable treatment alternative and should be offered to men age ≤55 years who present with organ-confined prostate cancer.