Diagnosed With Prostate Cancer At a Young Age

Prostate cancer is the most common cancer in males after skin cancer. However, not all of them are diagnosed.

Many prostate cancer cases can be slow-growing, and plenty of patients die from other causes.

Even if you are diagnosed with prostate cancer at an advanced age, your doctor may recommend avoiding aggressive therapy, depending on the case. That’s because it would make no sense to treat with chemotherapy or radiation therapy if cancer is unlikely to develop according to your life expectancy.

But what if you’re diagnosed with prostate cancer as a young man? You have a full life ahead of you, and it is not wise to neglect your condition. Even if you have a slow-growing and localized prostate cancer, you’ll probably be recommended to undergo therapy at some point.

In this article, we’re covering the topic thoroughly. After you read, you will understand what early-onset prostate cancer is. You will know what happens if you have this type of cancer and what increases your risk. Finally, we’ll talk about reducing your risk with different strategies and lifestyle modifications.

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How common is prostate cancer in young men?

According to the literature, early-onset prostate cancer is cancer that is diagnosed at 55 years old or before. Most cases are diagnosed after 60 years old, but you will be considered a young patient if you are 55 years or less. 

Let’s take every recorded prostate cancer case in the United States, which is around 240,000 cases. Early-onset prostate cancer would be approximately 10% of the total number (1,2). This number is almost 6 times higher as compared to 1986. But that doesn’t necessarily mean that more men are developing cancer.

It means that we’re getting better at diagnosing the condition. Since the introduction of prostate-specific antigens (PSA tests), more cases have been spotted before 55 years.

Survival Rate

Most men with prostate cancer have a favorable prognosis. After 5 years, their survival rate is near 100%. After 10 years, their survival rate is near 99% (2). This is even better when we detect the disease very early during prostate cancer screening. It allows doctors to take action and pay attention to cancer development, increasing the chance of survival.

Still, even young men with prostate cancer can have other associated diseases. They increase their risk and may turn prostate cancer treatment into a complex set of decisions to make. They could even require very aggressive treatment such as radical prostatectomy instead of more conservative options such as active surveillance. That’s why there’s a discrepancy in the survival rate.

Some studies say that regardless of when you develop the disease, the survival rate is the same. Others suggest that younger patients may have a lower survival rate.

This is striking because you would initially think that younger patients are healthier and fitter. They are being diagnosed early in the course of the disease. So, their survival rate should technically be higher. But that is not always the case. According to a study, patients diagnosed at age 55-79 have a 5-year survival rate of 100%. In contrast, patients diagnosed at age 20-54 have a 5-year survival rate of 98% (2).

What does it mean to get prostate cancer as a younger man?

Statistics about prostate cancer at a young age can be striking at first. You wouldn’t expect young patients to have a poorer prognosis. A study shed light on this by making a comparison in young patients with prostate cancer:

  • Most of them have low-grade prostate cancer

  • If they have high-grade prostate cancer, their prognosis is very poor

So, in other words, many of these cases are very mild prostate cancer. They are actually easier to control. But if you have high-grade prostate cancer diagnosed at a young age, that’s where the problem is (3).

Based on these findings, if you are diagnosed with prostate cancer at a young age, there are two possibilities:

  1. That you were simply diagnosed very early in the course of the disease

  2. That you have a rapidly-evolving and very dangerous cancer

These patients have a slightly poorer prognosis because some of them develop advanced prostate cancer as measured by the Gleason score. In the second possibility, there’s a high chance that you have a mutation or genetic variant that predisposes you to an aggressive disease. In other words, there’s something extra happening that contributes to cancer.

You can see this clearly in patients with a family history of prostate cancer. They are probably joining a genetic pool activated by environmental factors. Either way, that is why it is essential to know if you have prostate cancer in your family. It is even more critical if that case of prostate cancer was diagnosed before age 55 years.

Moreover, some urologists prefer to consider early-onset prostate cancer as a different subtype. The natural history of this subtype of cancer is more threatening, and it requires closer follow-up. Many researchers believe that the tumor growth phase before cancer starts giving problems shortens in these patients.

Undiagnosed cancer

For example, let’s take a man with undiagnosed cancer. The tumor starts growing at 40 years. It is the most common type of cancer, and the first symptoms show up at age 68 years. By comparison, early-onset prostate cancer does not take almost three decades to grow. It takes 1, 2, or three years. That’s why the patient is diagnosed at age 42 years. So, in theory, this type of cancer can be growing at a very fast pace.

Of course, everything can happen in the human body. We can also have cancer diagnosed at age 68. But it started growing at age 65, so it is also very aggressive. Thus, even if the age of onset is not the ultimate predictor, it suggests a more aggressive disease. 

Risk factors

We mentioned family history as a risk factor, and it is one of the most important. Not the only one, however. So, let’s examine each significant risk factor one by one. First, let us examine the prostate cancer risk factors in general. They are:

  • Increasing age: We know that prostate cancer is more common in older adults. So, increasing age is a significant risk factor. It means that, as you age, the chance of getting diagnosed gets higher. Of course, this can be a slow-progressing or a rather aggressive prostate cancer. Most men after age 80 have prostate cancer cells, even if they are not diagnosed. These cells usually have slow growth and take a lot of time to develop. The usual delay is 10 years before any symptoms start to show up. That’s a long time compared to early-onset prostate cancer, with a usual delay of 1 year or a bit more (4).

  • African American race: For some reason, African Americans are more likely to develop prostate cancer. Their risk is higher as compared to other races in America. This probably has to do with genetic variations. Plus, other environmental or social factors may contribute to the risk (5).

  • Family history of prostate cancer: This is one of the most critical risk factors. Your risk is increased two-fold or three-fold when you have prostate cancer relatives. The risk is even higher if they are multiple relatives and if they were diagnosed at a young age (6).

Risk factors in young patients

Early-onset prostate cancer is similar to breast cancer and endometrial cancer in one way. When patients are diagnosed at a younger age, a hereditary pattern is more likely. Thus, among the risk factors listed above, the most important in these patients is a family history.

Actually, a study found that family history is particularly relevant in men under 65 years. After 65 years, it may not increase the risk as much (7). These younger patients have a higher risk of genetic variants that increase the aggressiveness.

This increase in genetic burden is recorded in the scientific literature but is quite difficult to study. In the future, it will be very useful to know which genes are particularly risky. This would allow us to screen young patients with prostate cancer to see if they have these defective genes. If they do, they are at a notably higher risk and need to undergo aggressive treatment right away. However, this sounds very good in theory. Cancer is not as easy to manage and understand.

One of the few genes currently identified is a small change in the gene HOXB13. This gene encodes a transcription factor that modulates cell growth. In a mutant HOXB13 gene, cells start to divide rapidly independent from androgen stimulation. Patients with this defective gene are more likely to develop cancer at an early age (8).

Similarly, more than 70 genetic variants have been identified to assess a patient’s risk. However, a practical application in genetic tests is apparently not very useful as a predictive tool. That’s why there is currently no genetic risk model to apply in a clinical setting. But it is a likely possibility for future research.

Reducing risk

As you can see above, we have clearly identified many risk factors. There are even genetic tests going on, and they will probably be useful in the future. The goal of this information is to identify who is at risk to prevent prostate cancer. This is primary prevention. But there’s also secondary prevention, which is about preventing prostate cancer complications and mortality in diagnosed patients.

A good starting point to reduce the risk of prostate cancer and the risk of complications is evaluating our risk factors. The scientific evidence is not enough to create an effective protocol. If that were the case, the number of cases would be declining. But we do have many clinical trials and recommendations to reduce the risk, at least a bit.

One medication that is under study for prostate cancer prevention is finasteride. According to the Prostate Cancer Prevention Trial, this drug may reduce the chance of getting cancer. 25% of patients who took finasteride developed prostate cancer, which is an astounding number. However, apparently, it only prevents a few low-grade prostate cancers. Thus, using or not using this drug was not changing prostate cancer death (9). 

That’s why the FDA disapproves of finasteride for prostate cancer prevention. Even if previous trials found an exciting result, the clinical application is not what we expected. Moreover, the real problem with early-onset prostate cancer is aggressive cancer. As noted above, being diagnosed at a young age means either that you were simply diagnosed by chance or have a more dangerous prostate cancer variant.

What you can do right now, and it will be associated with plenty of benefits, is adopting a few lifestyle modifications to reduce the overall risk of prostate cancer and other conditions.

Diet and lifestyle modifications to reduce your risk

Maintain a healthy weight

Being overweight links with systemic inflammation. Fat cells produce inflammatory cytokines, and prostate cancer can make use of that for its advantage. That’s why obesity links with different types of cancer, including prostate cancer.

Avoid red meat fat

Saturated fat is another source of inflammation, and red meat has a lot. We can also find plenty of saturated fat in whole dairy and other animal products. Once in our body, saturated fat transforms into inflammatory substances. These substances are useful for body defenses, but those created from saturated fats are very aggressive and easily harm the body. Inflammation is used to feed prostate cancer and many other types of cancer. That’s why excess meat consumption can be associated with higher prostate cancer incidence.

Eat omega 3 food sources

Unlike saturated fat, omega-3 is also a type of fatty acid but a healthy type. Instead of creating aggressive inflammatory substances, omega 3 is transformed into protective substances that defend your body without causing harm. It also has anti-inflammatory effects on its own. Thus, it is a great nutrient to counter the effects of saturated fat in your diet. A great source of omega 3 is fatty fish, but you can also find this nutrient in many nuts and seeds.

Eat more tomatoes

These vegetables are rich in a substance known as lycopene. This is a phytonutrient, a substance that protects vegetables and has similar effects on the human body. Lycopene works as an antioxidant and prevents damage to the DNA. It is a fantastic way to reduce the risk of prostate cancer naturally. You can consume processed or cooked tomatoes, which are still more beneficial.

Watch your calcium intake

Excessive calcium intake is associated with a higher rate of prostate cancer. The recommendation would be to take your recommended daily allowance and no more. Do not get close to 1,200 mg a day, and stay away from exceeding that dose.

Do not smoke

Smoking has several carcinogens that increase the chance of prostate cancer. It also leads to several other diseases. So, it is an excellent idea to quit.

Control stress and chronic disease

Stress and chronic disease can increase the chance of cancer or worsen your prognosis. Enjoy life and reduce stress at home and in your workplace. Control your chronic disease with the right combination of meds, especially if we’re talking about hypertension or diabetes. Do not wait for the consequences to start taking care of yourself.

Stay in contact with your doctor

If you think that your prostate cancer risk is higher than the average, talk to your doctor. In some cases, you might need a few tests, such as a PSA test or a digital rectal examination. Remember that this PSA screening is not for everybody. They are usually recommended only for those who have a family history or urinary symptoms. Discuss the pros and cons with your doctor and make a decision of your own. We also recommend talking to your doctor if you decide to take medications or supplements to reduce your risk.

All of these recommendations won’t reduce the risk of prostate cancer to zero. But they will help you live a healthier life and reduce the chance of this and other ailments.

Conclusion

Cancer in the prostate gland and having an enlarged prostate are the most common ailments in the urology department. However, a prostate cancer diagnosis usually happens in older adults.

If you are diagnosed before 55 years, it will be considered early-onset prostate cancer. This type links with an increased risk of metastatic prostate cancer and other complications. Despite being younger, your risk is higher. That’s because you’re more likely to have a genetic predisposition to a more aggressive disease. Thus, the tumor’s progression didn’t take 10 or more years to develop but only 1 or 2.

Of course, there’s also a possibility that your tumor was simply discovered by chance, and you don’t have a very serious disease. But you need to talk about that with your doctor to find out what to expect and what to do next.

Your risk of early-onset prostate cancer increases if you have a family history. If they are very close members and had a diagnosis before 55 years, the risk is even higher. However, you can reduce the risk by living a healthy life. Adopting a few dietary modifications and keeping a healthy weight will do a lot for you. You also want to quit smoking and only drink alcohol occasionally.

If you follow these recommendations, the risk will not go down to zero. But you will likely have a lower incidence of long-term consequences. Plus, it will be an excellent lifestyle to maintain your quality of life for the years to come. 

Next Up

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Sources

  1. Siegel, R., Ma, J., Zou, Z., & Jemal, A. (2014). Cancer statistics, 2014. CA: a cancer journal for clinicians, 64(1), 9-29.
  2. Howlader, N., Noone, A. M., Krapcho, M., Neyman, N., Aminou, R., Altekruse, S. F., … & Cronin, K. A. (2012). SEER Cancer Statistics Review, 1975-2009. 2011. Bethesda, MD: National Cancer Institute.
  3. Lin, D. W., Porter, M., & Montgomery, B. (2009). Treatment and survival outcomes in young men diagnosed with prostate cancer: A population‐based cohort study. Cancer, 115(13), 2863-2871.
  4. Zelen, M., & Feinleib, M. (1969). On the theory of screening for chronic diseases. Biometrika, 56(3), 601-614.
  5. Howlader, N., Noone, A. M., Krapcho, M., Miller, D., Bishop, K., Kosary, C. L., … & Cronin, K. A. editorsSEER Cancer Statistics Review, 1975-2014. National Cancer Institute.
  6. Brandt, A., Bermejo, J. L., Sundquist, J., & Hemminki, K. (2010). Age-specific risk of incident prostate cancer and risk of death from prostate cancer defined by the number of affected family members. European urology, 58(2), 275-280.
  7. Chen, Y. C., Page, J. H., Chen, R., & Giovannucci, E. (2008). Family history of prostate and breast cancer and the risk of prostate cancer in the PSA era. The Prostate, 68(14), 1582-1591.
  8. Sreenath, T., Orosz, A., Fujita, K., & Bieberich, C. J. (1999). Androgen‐independent expression of hoxb‐13 in the mouse prostate. The Prostate, 41(3), 203-207.
  9. Thompson Jr, I. M., Goodman, P. J., Tangen, C. M., Parnes, H. L., Minasian, L. M., Godley, P. A., … & Ford, L. G. (2013). Long-term survival of participants in the prostate cancer prevention trial. N Engl J Med, 369, 603-610.

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