Early Onset Prostate Cancer: Prostate Cancer in Younger Men

In the United States, prostate cancer is the most common cancer found in men and the second leading cause of death of men. Approximately 12.5% of men will get prostate cancer in their lifetime and roughly 2.4% will die from it. Prostate cancer is known to mostly affect older men, with most prostate cancers found in men over the ages of 65. However, it is also possible to get prostate cancer at a younger age. This is known as early onset prostate cancer.

The definition of ‘younger’ has not been standardized across studies done on the topic, with the definition ranging from men below 50 to men below 60 years of age. Approximately, over 10% of newly diagnosed prostate cancer cases in the US occur in men younger than 55 years. For the past few decades, this proportion of prostate cancer cases in younger men has been steadily increasing. While it may be alarming, the increasing trend could indicate the improvement in early detection of prostate cancer. For example, there was a great increase in prostate cancer incidence after the introduction of serum prostate-specific antigen (PSA) testing for prostate cancer screening. Nevertheless, it is important to understand this upward trend and what early onset prostate cancer means for younger men.

The main difference between prostate cancer in younger men and that in older men is the nature of the cancer. Prostate cancer in younger men tends to be more aggressive. Since it is seldom recommended for younger men to go for prostate cancer screening, younger men tend to receive a diagnosis only when they experience noticeable prostate cancer symptoms (e.g. urinary symptoms or symptoms of metastatic disease), typically seen in advanced cases.

Prostate cancer in younger men is often linked to a slightly worse prognosis as compared to older men with the same cancer grade and stage. This is a difficult topic to study because younger men tend to have fewer comorbidities that might complicate treatment options. As such, younger men are often able to receive more aggressive treatments to treat their cancer — making a worse cancer have a more favorable outcome.

It is suggested that early onset prostate cancer may belong to a different subset of prostate cancer than typical cases of prostate cancer. For example, they may arise due to a different set of risk factors (e.g. genetics), or have a unique biology. However, research on this is still ongoing.

Is there a reason why younger men may develop prostate cancer? While there is no direct cause, there are multiple factors that may influence the prostate cancer risk of younger men.

• Family history

Those with family history of prostate cancer are two to three times more likely to develop prostate cancer, with added risk for multiple relatives who have had prostate cancer and relatives who were diagnosed at a younger age. This increased risk affects men younger than 65 more than it affects men 65 years and older. In other words, family history has a greater impact on younger men than on older men.

Family history essentially points to genetic variants that may be passed on from generations. It was found that men diagnosed with early onset prostate cancer are more likely to carry genetic variants that are associated with increased prostate cancer risk. Our understanding of the genes underlying prostate cancer risk has markedly advanced in the past decade and germline testing is now routine for many cases of prostate cancer, particularly in those diagnosed at a young age or with a strong family history.

• Race

Prostate cancer risk is not equal across all races. African American men have a higher risk of developing prostate cancer, having a more aggressive form of prostate cancer and are more likely to be diagnosed at a younger age. They also tend to have a lower survival rate as compared to their counterparts of other races.

• Diet and lifestyle

While diet and lifestyle have less time to play a significant impact on younger men, they may still influence one’s prostate cancer risk.

A population-based study determined that the primary choice of treatment for localized prostate cancer among young men and their healthcare providers is radical prostatectomy over other treatment methods. Radiation combined with or without hormone therapy is a common alternative to prostatectomy in localized prostate cancer. In advanced prostate cancer, radiation therapy, chemotherapy, hormone therapy, radiopharmaceuticals, immunotherapy, and PARP inhibitors also have a role.

Unfortunately, prostate cancer treatments run the risk of affecting fertility by lowering sperm counts or damaging nearby reproductive organs. Younger men who wish to conceive after treating prostate cancer should consider fertility preservation strategies before starting treatment. Relying on a sperm bank is one way to store healthy sperm safely, to ensure that one can still have kids after cancer treatment.

PSA testing is increasingly performed to screen for prostate cancer in men in their 40s following shared decision making. There are no formal recommendations on prostate cancer screening in younger men. It is crucial for younger men to be conscious of then they will begin prostate cancer screening, especially if they have family history of the disease or other risk factors. If you do have risk factors, it is best to consult a healthcare professional on your risk factors and screening options and recommendations.