Risk for prostate cancer in men under 40 years of age

A newly published paper by Blayer et al. in in the journal Cancer has stated that,

Worldwide, the incidence of prostate cancer has increased in all groups between ages 15 and 40 years and increased globally at a steady rate averaging 2% per year since 1990.

For some additional information you can see this report on the Healio web site.

Now before everyone under the age of 40 starts to panic and think that there is an “epidemic” of prostate cancer among younger males, we feel obliged to point out that we don’t find these new data surprising at all.

Prior to 1990 the number of young men under 40 being tested for risk of prostate cancer (let alone those as young as 15) would have been close to zero. A clinical finding of prostate cancer in a man under 40 is still rare, and a finding of potentially clinically significant prostate cancer (i.e., intermediate- or high-risk prostate cancer) in this group of men is even rarer. On the other hand, we do know that men who are diagnosed with clinically significant prostate cancer at such an age are at higher risk for metastasis and death from prostate cancer than men who are diagnosed when they are between 50 and 80 years of age:

Whereas the overall 5‐year relative survival rate in the United States for men diagnosed between ages 40 and 80 years was between 95% and 100%, it was 30% in those aged 15 to 24 years, 50% in those aged 20 to 29 years, and 80% in those aged 25 to 34 years.

We also have reason to believe that a man who is diagnosed with low-risk prostate cancer at 15 to 40 years of age may well be at increased risk for a later diagnosis with clinically significant prostate cancer (although this has yet to be proven).

Over the past 30 years, we have massively increased the use of testing for risk of prostate cancer among men in general and among men in high-risk cohorts (such as African Americans and those with familial risk for prostate cancer) in particular. Inevitably, we have therefore been able to identify prostate cancer earlier in these groups of men. However. …

Blayer et al. are very careful to point out in their paper that there is a lot we don’t know about the prostate cancers that are being diagnosed in these younger men:

There is some evidence that this may be caused in part by [historic] underdiagnosis, prostate‐specific antigen screening, and overdiagnosis. It also may be caused by trends in obesity, physical inactivity, HPV infection, substance exposure, environmental carcinogens, and/or referral patterns. How the biology of these cancers differs from that in older men and how the etiologies vary from country to country remain to be determined.

Another thing we don’t know from the abstract of the Blayer et al. paper (or the associated Healio report) is what percentage of the very young patients (between 15 and 24 years of age) were being diagnosed with unusual forms of cancer of the prostate as opposed to standard forms of adenocarcinoma of the prostate.

The increased attention that has been focused on risk for cancers like breast and prostate cancer in younger persons over the past 40 years or so has inevitably given rise to an increase in the probability of diagnosis of such cancers in persons who were not often considered to be at risk for these diseases 30 to 40 years ago. The critical and unanswered questions with regard to prostate cancer in particular are:

  • Why do some men get particularly aggressive forms of prostate cancer when they are so young?
  • What percentage of these young men with clinically significant prostate cancer can be given effective local treatment that eliminates their disease?
  • How does one best manage young men who are initially diagnosed with clinically insignificant prostate cancer? Can and should they be managed on active surveillance or should they be considered among the potentially prime candidates for focal therapy of their disease?

2 Responses

  1. We should also ask, how many of these young patients have a family history of prostate cancer.

  2. I have a problem with such publications that seem to be designed for media headlines. What is important are the absolute numbers (incidence per 100,000 population), not the relative increases. If the incidence rates in this age group are minuscule, what is the difference if the detection rate has increased by 2% a year, especially if that increase has been due to over-diagnosis? The potential harm caused by analyses like these is huge — the last thing we need is an increase in young men needlessly maimed by prostatectomies.

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