Prostate cancer in young men: an important clinical entity

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.).

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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.

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Correspondence to Kathleen A. Cooney.

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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). https://doi.org/10.1038/nrurol.2014.91

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