Not just for older guys
Cancer of the prostate gland — which produces fluid contained in semen — is one of the most common types of cancer in U.S. men. Prostate cancer is known as a disease of older men, and that’s largely true. The average age of diagnosis is 66, with about 10 percent of new cases in men under 55. Younger men with prostate cancer can face somewhat different long-term concerns, including possible effects on fertility from treatment. In April, an influential government panel updated recommendations for disease screening. If you’re a man in your mid-50s or younger, here’s what you should know about prostate cancer, testing, treatment and prevention.
Updated on May 9, 2017: This article was originally published on March 2, 2016.
Early onset cancer can be more aggressive.
Prostate cancer is the second-leading cause of cancer death among African-American, Hispanic and white men. Fortunately, however, five-year survival rates are very high, at nearly 99 percent. More than 3 million U.S. men are prostate cancer survivors. However, men diagnosed with prostate cancer at 55 or younger are more likely than others to eventually die from the disease itself, rather than outside causes, according to a May 2014 study in Nature Reviews: Urology. Researchers from the University of Michigan found that for certain types that strike at a younger age, tumors appear to grow more quickly and be more lethal.
Family history affects risk.
Prostate cancer diagnosed in younger men has a strong genetic component. Men with a family history of prostate cancer are known to be at higher risk of developing the disease. “Certain genetic variants have been shown to be associated with high risk of prostate cancer,” Dr. Scott Tomlins, an assistant professor of pathology at the University of Michigan, said in a 2016 interview with U.S. News. “Variants in genes like BRCA2 or BRCA1 — some of the same genes that put you at risk for breast cancer.” Men in higher-risk groups include African-Americans or men with a father, brother or son who was diagnosed with prostate cancer at an early age.
Symptoms tend to show later.
Usually, early prostate cancer doesn’t cause any symptoms. With more advanced cancers, urinary problems such as a weak or slow stream, or the need to urinate more often, particularly at night, may be signs. Blood in the urine is another symptom, as is erectile dysfunction. However, there could be a variety of other causes of these problems, like benign prostatic hyperplasia, or enlarged prostate, a noncancerous condition that’s common in older men. Bone pain in the hips, back, ribs and other areas can indicate prostate cancer that has spread. Numbness or weakness in the legs and feet are also possible symptoms. Talk to your health care provider if any of these issues arise.
Screening tests are simple.
You can be screened for prostate cancer in your doctor’s office with a simple blood test for prostate-specific antigen. While a PSA level at or below 4.0 ng/mL has traditionally been considered normal, the American Cancer Society recommends yearly testing for men with a PSA of 2.5 or higher. A digital rectal exam, to detect abnormal areas or lumps in the prostate, may also be part of screening.
When to be tested is less clear.
There’s controversy around prostate cancer screening guidelines — how often screening is needed and at what age to begin. Ultimately, it’s an individual decision — and discussion — between you and your health care provider. For men with average risk, discussions with doctors about prostate cancer screening should begin at age 50, according to the American Cancer Society. But men at high risk should consider screening at age 45. Men at even higher risk, such as those with several relatives with early prostate cancer, should consider screening when they turn 40, according to the ACS.
The jury is still out on screening younger men.
In April, an influential government panel, the U.S Preventive Services Task Force, revised its stance on PSA blood tests. Previously, the panel was opposed to routine screening at any age, since there are “harms” associated with prostate cancer treatment, including sexual impotence and urinary incontinence. The panel amended its guidelines based on emerging evidence supporting the benefit of those tests, since they reduce the risk among men ages 55 to 69 that cancer will spread to other parts of their body, and their risk of dying of prostate cancer. However, the new draft recommendations only apply to men in that age bracket — there’s currently not enough evidence to apply them to younger men. Still concerned about the potential harms of screening and treating younger, high-risk men, the group calls for more research in this area.
Baldness is linked to slightly higher risk.
Men with male-pattern baldness may have a slightly higher risk of developing fatal prostate cancer compared to men with a full head of hair, according to a study in the Jan. 12, 2016, issue of the American Journal of Epidemiology. The increased risk was 56 percent for men with any degree of balding, although the most conservative study estimate would be a 2 percent increased risk, according to co-author Dr. Michael Cook, an investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute. Much more research is needed to better understand the possible overlap between hair loss, male-hormone levels and disease risk, Cook emphasized in a 2016 email to U.S. News. “Men of any age and any balding status need not be additionally concerned about their individual risk of prostate cancer,” he concluded.
Age may affect treatment decisions.
At a younger age, finding prostate cancer — even a slow-growing variety — could tip the balance in making treatment choices. Surgery and radiation, either external or internal, are treatment mainstays for prostate cancer. The jury is still out on the value of more targeted, but more costly proton beam radiation for prostate cancer. Other standard treatments include chemotherapy, hormone therapy and biologic therapy. It’s important for a younger man diagnosed with prostate cancer to talk with his oncologist about the range of therapy options. Shared decision making — with patients getting the information they need to consider and discuss screening and treatment choices that incorporate their personal values — is part of the process.
Watchful waiting can work.
The emphasis is on “watchful.” Referred to as active surveillance in the medical community, watchful waiting during early-stage prostate cancer, with regular re-evaluation and imaging tests, can help men avoid overtreatment and related risks of urinary incontinence and sexual dysfunction. With the latest medical technology, called multiparametric MRI, doctors can follow disease progression in patients with much more precision. “It allows a urologist to visualize lesions in the prostate when they do a biopsy,” Tomlins said in last year’s U.S. News interview. “It also allows them to track where the biopsy went. And if they go back a year later, to try and biopsy that same area.”
Lifestyle counts.
When it comes to prostate cancer prevention, “The important lesson is for all of us to be concentrating on the things that we know reduce overall cancer risks — being physically active, trying to maintain a healthy weight and choosing healthy foods,” Dr. Richard Wender, chief cancer control officer for the American Cancer Society, said in a 2016 interview with U.S. News. “The good news is all the things that are good for preventing heart disease are good for preventing cancer, too,” he said, including an eating plan that incorporates plenty of fruits and vegetables.
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10 Things Younger Men Should Know About Prostate Cancer originally appeared on usnews.com
Update: This article was originally published on March 2, 2016.
