Prostate cancer in young men: an important clinical entity

Journal name:
Nature Reviews Urology
Volume:
11,
Pages:
317–323
Year published:
DOI:
doi:10.1038/nrurol.2014.91
Published online

Abstract

Prostate cancer is considered a disease of older men (aged >65 years), but today over 10% of new diagnoses in the USA occur in young men aged ≤55 years. Early-onset prostate cancer, that is prostate cancer diagnosed at age ≤55 years, differs from prostate cancer diagnosed at an older age in several ways. Firstly, 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. Secondly, early-onset prostate cancer has a strong genetic component, which indicates that young men with prostate cancer could benefit from evaluation of genetic risk. 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. For these reasons, patients with early-onset prostate cancer pose unique challenges, as well as opportunities, for both research and clinical communities. Current data suggest that early-onset prostate cancer is a distinct phenotype—from both an aetiological and clinical perspective—that deserves further attention.

At a glance

Figures

  1. Incidence of prostate cancer by age group during 1973-2008.
    Figure 1: Incidence of prostate cancer by age group during 1973–2008.

    a | The age-adjusted incidence of prostate cancer increased dramatically during the late 1980s and early 1990s as a result of screening with serum PSA. Since then, incidence has decreased or stabilized among most age groups. Although prostate cancer in men aged ≤55 years (early-onset prostate cancer) represents only a small proportion of all men diagnosed with this disease, incidence in this group continues to rise. b | Change in incidence in men aged 50–55 years at diagnosis, for whom screening was commonly recommended by most medical organizations. Incidence in this group increased after PSA screening was introduced, but has stabilized to some extent since 1999. c | Change in incidence among young men aged 20–49 who are not expected to have PSA screening. Incidence in this group has continued to rise. Data obtained from Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence–SEER 17 Regs Research Data, Nov 2011 Sub (1973–2010) <Katrina/Rita Population Adjustment>–Linked To County Attributes–Total U.S., 1969–2010 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2012, based on the November 2011 submission.

  2. Relative survival of men with prostate cancer by age at diagnosis (1994-2008).
    Figure 2: Relative survival of men with prostate cancer by age at diagnosis (1994–2008).

    The survival of men diagnosed with prostate cancer is compared to the survival of men with similar demographic characteristics from the US population using SEER data.4 A reduction in relative survival from 100% demonstrates the effect of death due to prostate cancer. Among men diagnosed during 1994–2008, those diagnosed with prostate cancer before the age of 60 years have worse 5-year and 10-year survival than men in all other age groups, except the elderly (aged >80 years at diagnosis). Data obtained from Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Mortality–All COD, Aggregated With State, Total U.S. (1969–2010) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released November 2011 and Centers for Disease Control and Prevention.93

  3. Natural history of prostate cancer.
    Figure 3: Natural history of prostate cancer.

    This figure illustrates the course of prostate cancer from initiation (A), to diagnosis by screening (B), to diagnosis by clinical symptoms (C), to clinically detectable metastatic disease (D), and finally to death from prostate cancer (E). The 'latency time' is the time from initiation (A) to diagnosis by screening (B) or clinical symptoms (C); the 'sojourn time' is the time between cancer initiation (A) and clinical detection (C) in an unscreened population. Thus, in the absence of screening, the latency time is equal to the time from initiation (A) to clinical diagnosis (C) and the lead time is zero. Survival is the time between cancer diagnosis (B or C, whichever occurs first) and death from the disease (E). In a screen-detected patient the point (C) is unobserved, and survival includes the lead-time.

  4. Change in mean latency time of prostate cancer in the US population by age during 1980-2010.
    Figure 4: Change in mean latency time of prostate cancer in the US population by age during 1980–2010.

    Introduction of PSA screening in 1988, and its increased utilization in subsequent years, led to shortening of latency time as cancer is now detected earlier. The impact of screening is dramatic for older ages, but the change for younger patients is much smaller because their sojourn times (latency in the absence of screening) are shorter, and they are also more likely to be missed by screening.34, 35

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Author information

Affiliations

  1. Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.

    • Claudia A. Salinas,
    • Miriam Ishak-Howard &
    • Kathleen A. Cooney
  2. Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.

    • Alex Tsodikov

Contributions

C.A.S., A.T. and K.A.C. researched data for the manuscript. C.A.S., M.I.-H. and K.A.C. made substantial contributions to discussion of content and wrote the article. A.T., M.I.-H. and K.A.C. reviewed the manuscript before submission.

Competing interests statement

K.A.C. has received grants from the National Institutes of Health (R01 CA79596, R01 CA136621, SPORE P50 CA69568). A.T. has received a grant from the National Institutes of Health (CISNET U01 CA157224, SPORE P50 CA69568). The other authors declare no competing interests.

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Author details

  • Claudia A. Salinas

    Dr Claudia A. Salinas received her PhD in Epidemiology in 2009 from the University of Washington, Seattle, WA, where she focused on genetic and other risk factors associated with prostate cancer. During her postdoctoral fellowship at the University of Michigan Comprehensive Cancer Center in Ann Arbor, MI, she continued this work examining the profile of prostate cancer among the youngest men who develop this malignancy. After her postdoctoral fellowship, Dr Salinas transferred her experience to industry and is now working in pharmacoepidemiology.

  • Alex Tsodikov

    Dr Alex Tsodikov gained his PhD in Applied Mathematics in 1991 from St Petersburg State Technical University, Russia. He was a postdoctoral fellow at the Institute Curie in Paris, France, a Biostatistician in Leipzig, Germany, and a faculty member at the University of Utah and at the University of California, Davis. Currently, Dr Tsodikov is Professor of Biostatistics at the University of Michigan School of Public Health in Ann Arbor, MI. He has published over 100 papers and worked on stochastic models of cancer and other diseases, and developed statistical methodology currently used in many cancer studies.

  • Miriam Ishak-Howard

    Dr Ishak-Howard received her MPH and more recently her PhD from the Department of Epidemiology at the University of Michigan School of Public Health, Ann Arbor, MI, in 2012. She is currently studying genetic epidemiology with respect to risk and treatment outcomes and her research focuses on advanced prostate cancer disease and prostate cancer recurrence.

  • Kathleen A. Cooney

    Dr Kathleen A. Cooney received her MD degree from the University of Pennsylvania School of Medicine in Philadelphia, PA, and clinical training in internal medicine and hematology/oncology at the University of Michigan Medical School (UMMS), Ann Arbor, MI. Dr Cooney is currently Chief of the Division of Hematology at UMMS and the Deputy Director for Clinical Services at the University of Michigan Comprehensive Cancer Center. She is a leading expert in the genetic epidemiology of prostate cancer and continues to practice medical oncology focusing on the care of men with advanced prostate cancer.

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