Prostate Cancer in Younger Men
Reviewed by: HU Medical Review Board | Last reviewed: June 2019 | Last updated: February 2023
Early-onset prostate cancer is roughly defined as prostate cancer that is diagnosed before age 55, and most research points towards genetic factors being responsible for its occurrence.3-5 Roughly 2 percent of deaths related to prostate cancer occur in those 35-54 years old.1
Although the median age for prostate cancer diagnosis is roughly 66 years old, with the highest proportion of those diagnosed between 65 and 74 years old, it is still possible to develop prostate cancer earlier on in life.1 Information on early-onset prostate cancer as well as its causes and trends are not very common in the literature.
With the number of cases of early-onset prostate cancer increasing by roughly six-fold over the past 30 years, interest in this research is growing.2 Possible factors may be environmental, such as smoking or diet, as well as more thorough and earlier screening methods.
With which stage of prostate cancer were you last diagnosed?
How common is prostate cancer in young people?
Common estimates suggest that early-onset prostate cancer comprises roughly 10 percent of all prostate cancer occurrences. As mentioned previously, the number of cases of early-onset prostate cancer is increasing, and has increased roughly six-fold from 5.6 to over 30 cases per 100,000 person-years since 1986. Additionally, and the same as with all prostate cancer diagnoses, the largest proportion of those diagnosed are African American males.1,2
What does having it at a younger age mean?
Early-onset prostate cancer is currently being investigated in order to better understand this group and their case presentations. Typically, those who are diagnosed at a younger age have been found to possess more genetic variants, or mutations that can contribute to cancer.
These individuals also typically have a familial history of the condition, with the greatest risk in those who have one or more close relative with early-onset prostate cancer. Findings like these suggest that early-onset prostate cancer is tied more to genetic factors that to environmental factors, such as smoking or diet.
General findings for those with high grade or stage early-onset prostate cancer trend towards a higher cause-specific mortality than their older counterparts. This means that individuals with aggressive early-onset prostate cancer are typically more likely to die from prostate cancer. This could be because they are less likely to die from conditions more present in older men. For example, a male at age 90 might have a heart condition in addition to his prostate cancer that may threaten his life more than a slow-spreading cancer.
The 5-year relative survival rate for those with early-onset prostate cancer is still very high, estimated to be 98 percent. However, this number is still lower than the nearly 100 percent five-year survival rate for slightly older men. The only men who show comparable survival rates under 100 percent are men ages 80 and older, who, as mentioned previously, may also be dying of causes other than prostate cancer.
Fortunately, the large majority of early-onset prostate cancer cases are local or low-grade. Even those whose cancer is found when it has spread beyond the prostate are typically lower in grade overall for younger men. Another advantage in this group is that there are typically more treatment options. Individuals are usually treatment-naïve (they haven’t had any other prostate cancer treatments or hormone therapies) and have less comorbidities (other health conditions) that could decrease treatment options.
For this reason, younger individuals with a Gleason score of 5-7 have a higher survival rate than older men with this same classification. Although the risk of cancer-specific death is higher for younger men, when their cancer is lower in grade and more local they have a better response to treatment than older men with the same cancer characteristics.2-6
When it comes to long term survivorship, because many sources recommend initiating treatment immediately for this population instead of taking the watch and wait approach that is common in older men, there can be a higher risk of long term side effects. In turn, the burden of these side effects is often greater for younger men who may not be mentally prepared for ED and other quality of life impacts while still in their prime.
Regardless of age, prostate cancer often starts without warning signs until it has advanced further. This is why it is important to engage in appropriate screenings and talk with your provider regularly about your risk and family history of cancer.
For young men especially, it may be beneficial to see a genetic counselor to look at your specific genetic risk. When prostate cancer manifests, early symptoms include increased urgency and frequency of urination, painful urination, blood in the urine or semen, erectile dysfunction, and pain in the pelvis, hips, thighs or lower back.
Rare atypical prostate cancers in very young men
One very rare form of prostate cancer, classified as a sarcoma, is typically found in younger men between 35 and 60 years old. This type of cancer makes up less than 0.1 percent of all cases of primary prostate cancer (meaning cancer that originates in the prostate). Sarcomas can infiltrate the soft tissues in the body. These tissues include our muscles and nerves. Since this tissue is essentially everywhere in our body, sarcomas can develop just about anywhere.
Sarcomas can break away from their original locations and spread to the bones or lungs. Two of the more common types of prostate cancer sarcomas are leiomyosarcomas and rhabdomyosarcoma which can affect very young men, including children. The important thing to note however, is that these atypical prostate cancers are incredibly rare.7-9