[Characteristics of metastatic prostate cancer occurring in patients under 50 years of age]. / Patrón de presentación del cáncer de próstata avanzado en pacientes menores de cincuenta años.

OBJECTIVE: To identify the clinical features, diagnostic approach, and treatment of metastatic prostate cancer in young adult patients. METHODS: A retrospective review was made of the clinical histories of patients under 50 years of age diagnosed with prostate cancer at the urology department of the National Institute for Neoplastic Diseases from 1952 to 2005. Demographic characteristics and data on history, symptoms, diagnostic procedures, treatment, and disease course were collected. Data were statistically analyzed and compared to information obtained from a literature search. RESULTS: There were 69 patients aged less than 50 years who had been diagnosed with prostate cancer, 60% of whom had metastatic tumors. Mean patient age was 45.5 years, with a lower range of 29. All patients reported bone pain, associated to other signs and symptoms such as spinal cord compression (19.5%), lower limb edema (17%), peripheral adenopathies (36.5%), and abdominal tumor (2.4%). All patients had bone metastases, of which 14.6% were in solid organs (lung and liver), 48.7% in retroperitoneum, and 7.3% in mediastinum. Initially, three patients were diagnosed a lymphoproliferative syndrome, one patient a retroperitoneal tumor of unknown etiology, and four patients a metastasis from an unknown primary tumor. Mean prostate-specific antigen (PSA) level was 795 ng/mL (3-6500). All pathologies were reported as poorly differentiated or undifferentiated. Mean survival was 16.1 months (1-84), and all patients died due to disease progression. CONCLUSIONS: Advanced prostate cancer is an uncommon condition in young adults. Its clinical presentation is atypical, as metastases may mimic other diseases. The course of disease is indolent, and prognosis is poor. In patients with risk factors, PSA testing should be started before 50 years of age.

Patrón de presentación del cáncer de próstata avanzado en pacientes menores de cincuenta años / Characteristics of metastatic prostate cancer ocurring in patients under 50 years of age

Objetivo: Identificar las características clínico-patológicas de presentación del cáncer de próstata avanzado en pacientes menores de 50 años. Material y métodos: Se revisaron retrospectivamente historias clínicas de pacientes menores de 50 años con diagnóstico de cáncer de próstata avanzado del departamento de Urología del Instituto Nacional de Enfermedades Neoplasicas de 1952–2005. Se recopiló datos de filiación, antecedentes, sintomatología, métodos diagnósticos, tratamiento y evolución de la enfermedad. Se analizó estadísticamente y evaluó comparativamente con la información obtenida en la revisión de la literatura. Resultados: Se encontraron 69 pacientes menores de 50 años con diagnóstico de cáncer de próstata de los cuales 41 (60%) fueron metastásicos. El promedio de edad fue 45,5 años con un rango inferior de 29. Todos refirieron dolor óseo, asociado a otros signos y síntomas como compresión medular (19,5%), edema en miembros inferiores (17%), adenopatías periféricas (36,5%) y tumor abdominal (2,4%). El 100% presentaba metástasis ósea, 14,6% en vísceras sólidas (pulmón e hígado), 48,7% en retroperitoneo y 7,3% en mediastino. Inicialmente, 3 casos fueron catalogados como síndrome linfoproliferativo, uno como tumor retroperitoneal de etiología a determinar y 4 como metástasis de primario no conocido. El promedio del antígeno prostático especifico fue 795ng/ml (3–6.500). Todas las patologías fueron informadas como pobremente diferenciadas o indiferenciadas. La sobrevida promedio fue 16,1 meses (1–84), todos fallecieron por evolución de la enfermedad. Conclusiones: El cáncer de próstata avanzado en pacientes adultos jóvenes es una patología poco frecuente. La presentación clínica no es la típica, las metástasis pueden simular otras patologías. La evolución es torpida, con pronóstico pobre. En pacientes con factores de riesgo, se debe iniciar el estudio del antígeno prostático especifico antes de los 50 años (AU)

Objective: To identify the clinical features, diagnostic approach, and treatment of metastatic prostate cancer in young adult patients. Methods: A retrospective review was made of the clinical histories of patients under 50 years of age diagnosed with prostate cancer at the urology department of the National Institute for Neoplastic Diseases from 1952 to 2005. Demographic characteristics and data on history, symptoms, diagnostic procedures, treatment, and disease course were collected. Data were statistically analyzed and compared to information obtained from a literature search. Results: There were 69 patients aged less than 50 years who had been diagnosed with prostate cancer, 60% of whom had metastatic tumors. Mean patient age was 45.5 years, with a lower range of 29. All patients reported bone pain, associated to other signs and symptoms such as spinal cord compression (19.5%), lower limb edema (17%), peripheral adenopathies (36.5%), and abdominal tumor (2.4%). All patients had bone metastases, of which 14.6% were in solid organs (lung and liver), 48.7% in retroperitoneum, and 7.3% in mediastinum. Initially, three patients were diagnosed a lymphoproliferative syndrome, one patient a retroperitoneal tumor of unknown etiology, and four patients a metastasis from an unknown primary tumor. Mean prostate-specific antigen (PSA) level was 795ng/mL (3–6500). All pathologies were reported as poorly differentiated or undifferentiated. Mean survival was 16.1 months (1–84), and all patients died due to disease progression. Conclusions: Advanced prostate cancer is an uncommon condition in young adults. Its clinical presentation is atypical, as metastases may mimic other diseases. The course of disease is indolent, and prognosis is poor. In patients with risk factors, PSA testing should be started before 50 years of age (AU)