Prostate Cancer in Young Men

Early onset prostate cancer - more aggressive subtype often linked to genetic mutations

The number of younger men diagnosed with prostate cancer has increased nearly 6-fold in the last 20 years, and the disease is more likely to be aggressive in these younger men, according to a new analysis from researchers at the University of Michigan Comprehensive Cancer Center.

Prostate cancer is considered a disease of older men, aged >65 years. Many prostate cancers are slow-growing and many older men diagnosed with early stage prostate cancer will end up dying from causes other than prostate cancer.

Early onset prostate cancer, that is prostate cancer diagnosed at age ≤55 years, is a distinct phenotype, from both an aetiological and clinical perspective.

An entity that differs from prostate cancer diagnosed at an older age in several ways

Among men with high-grade and advanced-stage prostate cancer, those diagnosed at a young age have a higher cause-specific mortality than men diagnosed at an older age, except those over age 80 years. This finding suggests that important biological differences exist between early onset prostate cancer and late onset disease.

Furthermore, although the majority of men with early onset prostate cancer are diagnosed with low-risk disease, the extended life expectancy of these patients exposes them to long-term effects of treatment-related morbidities and to long-term risk of disease progression leading to death from prostate cancer.

“Early onset prostate cancer tends to be aggressive, striking down men in the prime of their life. These fast-growing tumors in young men might be entirely missed by screening because the timeframe is short before they start to show clinical symptoms,” says Dr Kathleen Cooney, professor of internal medicine and urology at the University of Michigan and senior author of the article. 

Men with a family history of prostate cancer have a two- to three-times greater chance of being diagnosed with prostate cancer. That risk increases for young men with multiple affected relatives.

The new analysis, which appears in Nature Reviews Urology, found that men with early onset prostate cancer has a strong genetic component, which indicates that young men with prostate cancer could benefit from evaluation of genetic risk. The researchers suggest that genetic counselling or increased surveillance in younger men with a family history of prostate cancer may be warranted.

Furthermore, although the majority of men with early onset prostate cancer are diagnosed with low-risk disease, the extended life expectancy of these patients exposes them to long-term effects of treatment-related morbidities and to long-term risk of disease progression leading to death from prostate cancer. 

“The unexpectedly poor prognosis of advanced stage early onset prostate cancer supports the idea that a new clinical subtype might exist in the subset of men with early onset prostate cancer. This subtype is more aggressive and requires more specialty expertise, including genetic sequencing,” Cooney says.

The study was funded by USA National Cancer Institute grants R01 CA79596, R01 CA136621, P50 CA69568, U01 CA157224.

The authors disclosed no conflict of interest. 

Reference 

Salinas C, Tsodikov A, Ishak-Howard M,et al.Prostate cancer in young men: an important clinical entity. Nature Reviews Urology 2014; 11: 317–323.

Link 

http://www.ncbi.nlm.nih.gov/pubmed/24818853