Prostate Cancer in Younger Men

When prostate cancer is diagnosed in people younger than age 55, it is called early-onset prostate cancer. Younger people with prostate cancer tend to have worse health outcomes. In fact, men under age 50 have the lowest 5-year survival rate of prostate cancer when accounting for all stages of the disease.^1,2

Genetic and socioeconomic risk factors seem to play a larger role for younger people than for older people. Talk to your doctor about your risk for prostate cancer. They can help you understand the benefits and risks of genetic and other tests.^2,3

How common is early-onset prostate cancer?

The median age for prostate cancer diagnosis is 67. More than 70 percent of men with prostate cancer are diagnosed between 55 and 74 years old. However, it is still possible to develop prostate cancer at a younger age. Less than 10 percent of men with prostate cancer are diagnosed before age 55.¹

African American men have the highest rate of prostate cancer diagnosis. They also are often diagnosed at a younger age. This means that African American men tend to develop prostate cancer earlier than men of other races.^1,4

Over the last 30 years, men under 55 years old have seen the largest increase in prostate cancer diagnoses. Several trends may explain this increase, including:^1,2,5

1. Better methods to detect and diagnose prostate cancer in younger men
2. Use of prostate-specific antigen (PSA) screening during this time
3. Overdiagnosis of prostate cancer
4. Changing racial, ethnic, and family factors
5. Higher exposure to toxins in the environment
6. Increasing rate of obesity and decreasing activity levels

Since 2010, the rate of early-onset prostate cancer diagnoses has started to decrease. This may be a result of reduced use of PSA screening at all ages.^1,5

What are the risk factors for early-onset prostate cancer?

Things that may raise a person’s risk for prostate cancer at any age include:⁴

• African American ancestry
• Family history
• Inherited genetic changes
• Exposure to certain chemicals

For younger people, family history plays an even more significant role. A positive family history of prostate cancer is linked to a higher risk in younger men than in older men. The risk may be even higher for men with several affected relatives, especially if those relatives were diagnosed at a younger age.³

People with early-onset prostate cancer tend to have more disease-related genetic changes. This may mean that younger people have a separate subtype of prostate cancer. A genetic counselor can help determine the subtype.^2,3

Socioeconomic factors also play a role in early-onset prostate cancer. These factors include income and education levels. Having a low socioeconomic status has been linked to lower overall survival in people with early-onset prostate cancer. This may be because of reduced access to health insurance, medical information, and treatments.²

What are the outcomes of early-onset prostate cancer?

Information about early-onset prostate cancer is limited. Experts are studying how to improve diagnosis and treatment for younger people with prostate cancer.⁵

In general, early-onset prostate cancer tends to be more aggressive. Most younger people diagnosed with prostate cancer have localized cancer. But tumors in younger people tend to spread (metastasize) faster. So, younger men are more likely than older men to be diagnosed with metastatic cancer.^5,6

Men diagnosed with prostate cancer before age 55 are more likely to die from prostate cancer. This may be because younger men have:^2,6

• Faster growing tumors
• Higher chance of being symptomatic at time of diagnosis
• Higher risk of underdiagnosis
• Lower risk of dying from other conditions that are more common in older men

The overall 5-year survival rate for men with early-onset prostate cancer is lower than that for men diagnosed later. But it is still quite high. The overall 5-year survival rates are:^3,5,6

• 99 percent for men diagnosed between 65 and 74 years old
• 98 percent for men diagnosed between 50 and 64 years old
• 96 percent for men diagnosed under 50 years old

The overall 5-year survival rate may be as low as 30 percent for men diagnosed under age 25.⁵

How are younger men with prostate cancer treated?

Younger people with prostate cancer may have more treatment options than older people. They usually have not had any other prostate cancer treatments. And they tend to have fewer other conditions that could limit treatment options.^3,7

Surgical removal of the prostate (radical prostatectomy) may be an option for younger people with prostate cancer if the cancer has not spread outside of the prostate. Radiation therapy and hormonal therapies are also potential options.⁵

Because younger people with prostate cancer tend to start treatment immediately, they have a higher risk for long-term side effects. The burden of side effects may also be greater. For example, erectile dysfunction can have a greater impact on quality of life for younger men.⁷