Although the median age of prostate cancer diagnosis is 66 years old, and the highest proportion of individuals are diagnosed between 65 and 74 years old, the condition can develop at varying times within a man’s life cycle.1
Prostate cancer does not discriminate
Prostate cancer is typically considered an older man’s condition and is associated with aging, however, the rate of early-onset prostate cancer has increased roughly six-fold in the past 30 years.2 It is not clear whether or not this increase is due to a shift in the demographic of those commonly affected by prostate cancer, or if these increased numbers are a result of better screening techniques (like the PSA test) and a wider range of individuals being tested.
On the other end of the spectrum, the general population is experiencing an increase in overall life expectancy due to advances in medicine and technology. It has been estimated that the number of individuals older than 65 years old will increase four times by 2050 when compared to the year 2000.3 Since prostate cancer typical develops and is found later in life, a larger population of men living longer will likely lead to an increase in the number of cases diagnosed in the elderly.
Prostate cancer in young men
Prostate cancer in men under 55 is considered early-onset prostate cancer, and is incredibly rare. Approximately 10 percent of all prostate cancer cases fall into this group. On average, this group typically experiences good prognoses and more treatment options than their older counterparts. This is in part due to few comorbid conditions and a life expectancy great enough to outweigh the potential risks and costs of treatment. Early-onset prostate cancer is typically associated with genetic factors, such as genetic mutations, instead of environmental factors like exposure to agent orange, diet, or smoking. Knowing this, it isn’t surprising to learn that early-onset prostate cancer often runs in the family and has a hereditary component. Because this group is slowly increasing in both numbers and awareness, early-onset prostate cancer is a common topic of debate and research.1,2
Prostate cancer in older men
Typically, older men are already associated with prostate cancer, and the median age of diagnosis, 66 years old, suggests this as well. Over 90 percent of prostate cancer cases occur in men over the age of 55. Some evidence has even estimated that nearly half of all men between the ages of 70 and 80 years old have microscopic evidence of the condition. When deciding on the best treatment options for a specific prostate cancer case, it is important to weight the potential costs of treatment, including detrimental impacts to quality of life, against an individual’s potential life expectancy.
The older a man is at the time of prostate cancer diagnosis the fewer years he most likely has in his estimated life expectancy. In men with less than 10-20 years remaining in their life expectancy, who also have locally advanced or slow-growing cancer, it may be better to forego treatment that could be difficult to handle in favor of a watch and wait approach. Although more men die much later in life with prostate cancer, a large proportion of these deaths are from other causes related to comorbid conditions or the aging process in general. With the amount of older men set to grow within the population, many studies have shifted to focus on treatment options, or lack thereof, for elderly individuals with prostate cancer.1,3,4
Role of comorbidities
Comorbid conditions are conditions that are exist alongside of a primary condition. For example, an individual with prostate cancer may also have depression, hypertension, or COPD (chronic obstructive pulmonary disease) at the same time. Each additional condition counts a comorbidity, and an increasing number of comorbidities are often associated with getting older. Therefore, the older the man is with prostate cancer, the more comorbidities he might have on average.
Comorbidities can vary in their effects, with some individuals possessing multiple additional conditions and still being relatively healthy, while others may possess one or two debilitating comorbidities that would impact their ability to respond to or handle treatment. When your provider or health care team is developing your treatment plan, they will often carefully consider the role of any comorbidities. Oftentimes, in older men specifically, a comorbidity may be severe enough to negatively impact life expectancy on its own, making a watch and wait approach for prostate cancer a better option overall.5,6