Prostate cancer in young men: an important clinical entity

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Key Points

  • The incidence of prostate cancer in young men (aged ≤55 years) has increased sharply over the past two decades, making early-onset prostate cancer an important emerging issue for public health

  • Increased screening in young men could account for some, but not all, of the increase in incidence of early-onset prostate cancer

  • Advanced-stage and high-grade early-onset prostate cancer might be a distinct clinicopathological subtype with more rapid progression to disease-specific death than late-onset prostate cancer of similar stage and grade

  • Men with early-onset prostate cancer tend to have a greater genetic risk than their older peers, making this group an ideal resource for investigating genetic susceptibility to prostate cancer

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.

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Figure 1: Incidence of prostate cancer by age group during 1973–2008.
Figure 2: Relative survival of men with prostate cancer by age at diagnosis (1994–2008).
Figure 3: Natural history of prostate cancer.
Figure 4: Change in mean latency time of prostate cancer in the US population by age during 1980–2010.

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Acknowledgements

The authors' research work was supported by NIH research grants no R01 CA79596 (K.A.C.), R01 CA136621 to (K.A.C.), SPORE P50 CA69568 (A.T., K.A.C.) and CISNET U01 CA157224 (A.T.).

Author information

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.

Correspondence to Kathleen A. Cooney.

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Competing interests

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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Salinas, C., Tsodikov, A., Ishak-Howard, M. et al. Prostate cancer in young men: an important clinical entity. Nat Rev Urol 11, 317–323 (2014) doi:10.1038/nrurol.2014.91

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