Prostate cancer and younger men
Prostate cancer is one of the most common cancers in men, with 1 in 8 men receiving a diagnosis in their lifetime. While it’s typically considered a disease of older men, studies indicate that prostate cancer (like colon cancer and other cancers) is on the rise among younger men. According to the American Cancer Society, about 10% of prostate cancer diagnoses in the United States are in men under 55 years old, though prostate cancer in men in their teens or 20s is very rare. However, younger men with prostate cancer can face somewhat different long-term concerns, including possible effects on fertility from treatment. Black men are also at higher risk for early onset and more aggressive forms of prostate cancer.
Doctors encourage young men to maintain a healthy lifestyle to lower their risk of developing prostate cancer. But, because the disease tends to strike later in life, they encourage people not to stress about their risks prematurely. Here’s what younger men should know about prostate cancer:
1. Prostate cancer is rare in younger men.
When it comes to prostate cancer, doctors say — typically — the lower your age, the lower your risk level.
According to the National Cancer Institute’s Surveillance, Epidemiology and End Results Program’s predictions for 2024, more than 60% of prostate cancer cases occur in those 65 and older, with the median age at diagnosis being 67. Only 6.7% of prostate cancer cases occur in men ages 35 to 54.
Dr. S. Adam Ramin, a board-certified urologist, urologic oncologist and the medical director of Urology Cancer Specialists in Los Angeles, says it’s both “extremely” and “exceedingly” rare for a 20-year-old male to have prostate cancer. Among the thousands of patients he has treated over the last 20 years, Ramin says he has only seen two or three patients who have been in their mid-thirties. The youngest patient he treated was 35.
Nevertheless, about 10% of new diagnoses occur in men aged 55 or younger, and these early-onset cancers often have a worse prognosis as the tumors tend to be more aggressive.
2. Prostate cancer risks can increase with age.
One of the reasons prostate cancer is uncommon in younger men is because risks accumulate over time.
Ramin explains that prostate cancer is thought to be “a hormonally driven type of cancer,” primarily influenced by testosterone. He notes that someone must have “enough of a lifetime exposure to testosterone,” for prostate cancer risks to arise. Older men have likely been exposed to more cumulative testosterone over their lifetime than younger men, he adds.
According to the National Cancer Institute, early-stage prostate cancer needs androgens, or male sex hormones, to grow. The two primary androgens are testosterone and dihydrotestosterone, or DHT. To combat this, men with prostate cancer are sometimes given hormonal blocking treatments to reduce their production of testosterone and DHT. However, as the cancer mutates or changes, it becomes less responsive to hormonal manipulation and can continue growing regardless of castration or low levels of testosterone.
Despite the above, studies have found that taking hormonal therapies to increase testosterone production does not appear to increase the risk for developing prostate cancer, if the therapy is used for a moderate period of time. A 2018 study examined men with low starting testosterone levels and normal prostate cancer screening tests, finding no increased risk from testosterone-boosting therapies used for up to 12 months.
In addition to hormone exposure, Ramin says there are likely “other genetic factors that essentially become ‘expressed’ — or genes that start getting turned on — in later phases of a person’s life,” further explaining why prostate cancer risks increase with age.
3. How prostate cancer screening works
To check for prostate cancer, one of the first things your doctor may do is administer a prostate cancer screening test. Screening tests are not recommended for everyone and are rarely offered for men younger than 40 unless they show symptoms of prostate cancer or they have a strong family history.
A typical prostate cancer screening test involves a blood test for prostate-specific antigen, or PSA. A digital rectal exam, to detect abnormal areas or lumps in the prostate, may also be part of screening. High PSA levels can indicate that you may be at risk for prostate cancer — or it could be due to underlying inflammation in the prostate. However, a screening test alone is not sufficient for a prostate cancer diagnosis — which can require additional steps like a biopsy.
If your screening reveals a high PSA level, you can then decide whether or not to undergo further diagnostic testing. Also, if your screening reveals a high PSA number, it can be a good idea to get follow-up screening in years to come. Your physician should guide you in the next steps and review risks and benefits.
For men with a PSA level of 2.5 or higher, the ACS recommends annual PSA testing. Those with a PSA level of 2.5 or lower may only need to be tested every other year.
4. Prostate cancer screenings aren’t universally recommended.
The ACS does not currently recommend prostate cancer screening for all men. However, they suggest that all men have a chance to make an informed decision about whether or not to get screened. These discussions should take place between ages 40 and 50, depending on a person’s risk level. Higher risk can by influenced by factors such as race or a family history of prostate cancer.
Specifically, the ACS recommends starting the conversation with a health care provider at:
— Age 40, for men who have more than one first-degree relative (such as a father or brother) who was diagnosed with prostate cancer before age 65
— Age 45, for men who have one first-degree relative who was diagnosed with prostate cancer before age 65, and for people who are Black or African American
— Age 50, for men who are at average risk for prostate cancer and expected to live more than ten more years Screening is not recommended for men who are younger than 40, due to the “low likelihood of prostate cancer” in younger men, says Dr. Justin Tiulim, a hematologist and oncologist at Hunt Cancer Center at Torrance Memorial Medical Center in Torrance, California.
Tiulim adds that PSA tests can at times produce false positives, later leading to unnecessary invasive testing and anxiety, especially in this young population. Even at age 40 and above, people may choose not to get screened for these reasons.
Sometimes, false positives result from infections, recent instrumentation, ejaculation or trauma — all of which can raise PSA levels, Tiulim says.
For some men, who have a family history, for example, genetic testing may be worth pursuing. Inherited mutations in BRCA1 and BRCA2 genes increase the risk of developing hereditary prostate cancer. Around 10% of all prostate cancers are linked to inherited gene changes. Tell your doctor if you have a family history of prostate cancer.
5. Why an “early screening” at 40 is early enough
Research shows that early prostate cancer screenings may be able to predict future prostate cancer risk. But in this context, “early” still means age 40 and above. For younger men, doctors and health organizations recommend waiting until your 40s or 50s to discuss screenings, expressing caution toward testing prematurely.
One reason for this recommendation is that PSA levels can fluctuate, such as due to infections or physical activity, making them less reliable for younger men. As Tiulim explains, over time, “PSA levels can change, dependent on multiple factors.”
Additionally, tools like risk calculators designed to estimate an individual’s risk for prostate cancer are primarily used to determine if patients should proceed with biopsy or not, rather than for general screening purposes. “These have not yet been validated by randomized clinical trials,” Tiulim adds, meaning their accuracy and reliability have not yet been thoroughly tested in the most rigorous type of scientific study.
Another reason for hesitancy, according to the ACS, is the potential for PSA tests to produce false positive results, which can lead to anxiety and even unnecessary treatment. Prostate cancer treatments, like radical prostatectomy, can impact men’s sexual function and fertility, potentially conflicting with their future sexual or family goals. While these side effects can be worth it to save someone from cancer, they are less desirable if someone is low-risk and had a false positive test.
Once men reach the age when screenings are recommended, Ramin encourages patients not to be scared away by false positives. Doctors shouldn’t base their decision to conduct surgery solely on PSA tests; they’ll conduct further diagnostic testing and evaluations before determining if someone has prostate cancer and how it should be treated, he says.
6. When to seek medical attention for prostate-related symptoms
Young men can feel relatively confident that they will not come down with prostate cancer. But that doesn’t mean they are 100% in the clear. If you have a family history of prostate cancer or experience any red-flag symptoms, it could be a good idea to get checked out.
Likely, a visit to the doctor will alert you that you are experiencing a different problem — which your doctor should be able to help you treat or manage. Still, in the off chance that they hand you a suspected prostate cancer diagnosis, this is important to take seriously.
Many potentially prostate-related symptoms fall under urinary- and pain- based symptom categories. Some of these include:
Urinary symptoms
— Frequent urination, defined as urinating more than every three hours if not also drinking a lot of fluid
— Nighttime urination
— Feeling like you’re not emptying your bladder after urinating
— Significant slowing of urination
— Having the urge to constantly urinate
— Leaking urine with an urge to urinate
— Straining during urination
— Blood in urine or semen
Pain symptoms
— Painful urination
— Suprapubic pain, or pain above the pubic bone area or in the lower abdomen
— Perineum pain, or pain on the area the person sits, between where the scrotum ends and the anus begins. Deep-seated perineum pain can be a signal of a prostate-related issue, such as prostate cancer, and is important to get checked out, Ramin says.
Dr. Richard Wender, professor and chair of the Family Medicine and Community Health department at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, adds that the above pain symptoms may be a sign that prostate cancer has progressed to a later stage — or indicate that someone is experiencing a different issue altogether.
“Like most solid cancers that are common in adults, symptoms usually don’t occur until the cancer is beyond its earliest stages,” Wender says. “And the very earliest prostate cancers are very unlikely to be associated with symptoms.”
He adds that in some cases, men may experience urinary symptoms from having an enlarged prostate, and not prostate cancer. When this happens, symptoms may be coming from the prostate being big rather than from having cancerous cells in the prostate gland, he says.
To verify, see your primary care doctor for any initial symptoms, but seek out a specialist — like a urologist — if symptoms persist or worsen.
7. Prostate cancer in younger men tends to be more aggressive.
Ramin says that because prostate cancer is so unlikely in younger men — and because screenings are not recommended for people under 40 — cases that are detected based on symptoms could be more aggressive.
“Because it’s so rare to develop prostate cancer in a much younger population, when it does happen, it may be because of a more significant genetic derangement rather than just old age testosterone exposure,” Ramin says.
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. Researchers from the University of Michigan found that for certain types of prostate cancer that strike at a younger age, tumors appear to grow more quickly and be more lethal.
8. A healthy lifestyle matters.
Unfortunately, there is no Food and Drug Administration-approved vaccine to prevent prostate cancer. And there is no one exercise or diet plan that can reduce risks altogether, either. However, you may be able to reduce your risk to an extent by incorporating healthy lifestyle habits into your daily routines.
These can include:
— Following a nutritious diet and avoiding processed foods
— Maintaining a healthy weight
— Being physically active
— Avoiding all tobacco products
— Limiting alcohol intake
The good news is, many of these habits can benefit other areas of health, like supporting a healthy weight and heart disease prevention, in addition 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,” Wender says.
What younger men should know about prostate cancer:
1. Prostate cancer is rare in young men
2. Why prostate cancer risks can increase with age
3. How prostate cancer screening works
4. Prostate cancer screenings aren’t universally recommended
5. Why an “early screening” at 40 is early enough
6. When to seek medical attention for prostate cancer-related symptoms
7. Prostate cancer in younger men tends to be more aggressive
8. A healthy lifestyle matters
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What Younger Men Should Know About Prostate Cancer originally appeared on usnews.com
Update 07/10/24: This story was previously published at an earlier date and has been updated with new information.
