Prostate Cancer Risk in Younger Men

Although older men face a higher risk for prostate cancer, the risk still exists for younger men. If you’re younger than 60, we asked Senior Consultant Urologist Dr. Lie Kwok Ying what you should know about your risk. 

Longer life expectancy and widespread use of prostate-specific antigen (PSA) screening have increased the number of men diagnosed with prostate cancer. 

Prostate cancer is one of the top three most common cancer diagnosed in males in Singapore. It accounts for 12% of all male cancers diagnosed from 2008 to 2018¹.

How common is prostate cancer among younger men?

While prostate cancer is typically and closely associated with an older man’s disease, 8% of Singaporean men between 50-59² were diagnosed with prostate cancer between 2014-2018.   

While it is still considered a small proportion, the reality is that it does occur in younger men.

“The probability of developing prostate cancer increases from 0.005% in men younger than 39 years to 2.2% in men between 40 and 59 years,” said Dr. Lie.

“Although the chance of developing prostate cancer in a younger man is low, the number of younger men diagnosed with prostate cancer has increased nearly 6-times in the last two decades.  The disease is likely to be more aggressive in these younger men,” he cautioned.
 

At what age should younger men start prostate cancer screening?

“These fast-growing tumours in young men might be entirely missed due to current recommendations by screening guidelines,” he said.

The current Ministry of Health (MOH) guidelines published in 2010^₃ suggest that offering men between 50-75 years of age with an expected life expectancy of more than ten years prostate cancer screening. They can do so after discussing the potential benefits and harm associated with cancer screening with their physician.

The MOH’s recommendations and guidelines are not unique to the Singapore population only.

“The American Cancer Society (ACS) recommends that men make an informed decision after consulting with their doctor whether to have their PSA checked for prostate cancer. Starting at age 50, men should talk to their doctor about the risks and benefits of PSA testing to make a decision. The ACS also recommends that men that have a father or brother who were diagnosed with prostate cancer before age 65 should have this discussion with their doctor at age 45. After an informed discussion, younger men can make a decision to begin PSA testing to screen for prostate cancer,” Dr. Lie cited ACS as a reference.

Prostate cancer usually has no physical symptoms in the earlier stages. As a result, if aggressive prostate cancer is diagnosed in men younger than 55, the cancerous cells would have progressed to late-stage cancer that is more difficult to treat.

Hence in specific populations, such as men with a family history of this type of cancer, it is recommended to begin screening earlier. The risk is also higher if a genetic mutation in the family may predispose them to prostate cancer.
 

Inheriting prostate cancer

Your familial risk of prostate cancer is most significant if you have a first-degree relative diagnosed at a relatively young age.

“The risk factor for a man is two to three times more if his father, brother or son had it. The age that the family member was diagnosed is also a vital factor,” he explained.

“About 5 to 10 percent of all prostate cancers found are hereditary. That means there is a greater chance of the disease running in the family. Prostate cancer tends to be more aggressive in men who have certain inherited genetic mutations compared with men without these inherited mutations.”

He highlighted that some genes linked to prostate cancer also could cause breast, ovarian and other cancers. In addition, these genes have a 50 percent chance of being passed on to children. The most well-known of these genes are BRCA1 and BRCA2.

“The risk further rises with the number of family members who have breast cancer, and ovarian cancer.”

Based on your family history and other factors, your physician can help assess your overall risk of prostate cancer and guide you about genetic testing and counseling decisions.

According to Dr. Lie, there are generally three groups of men who should consider genetic counseling and testing for prostate cancer:

1.Men with or without a personal history of prostate cancer but have a family history of prostate, breast, colon, ovarian, or pancreatic cancers, especially if any of these are diagnosed under age 50.

2.Men with metastatic prostate cancer. Studies have shown that genetic mutations may be more common in men with metastatic prostate cancer.

3.Men who are concerned about their risk factors. Knowing if you have an inherited risk of prostate cancer helps you make better-informed decisions about your health and take actions to lower risks. 

Treating prostate cancer in younger men

A younger man living with prostate cancer may have different concerns and priorities than older men with prostate cancer. For example, their children may be still young, the financial responsibilities, or they may be looking for a life partner and looking ahead, a longer life expectancy. 

 “In younger patients with clinically organ-confined disease, radical prostatectomy is offered increasingly over the alternatives based on radiotherapy, such as external-beam radiotherapy and brachytherapy,” said Dr. Lie.

However, Dr. Lie cautioned the two main complications of prostatectomy: loss of urinary continence and sexual function. “Nerve-sparing techniques are possible in prostatectomy without sacrificing cancer outcomes,” he added.

Ultimately, the most appropriate option for you depends on your age, the stage of the disease, the severity of symptoms, and your general health. After finding out more about the grade and stage of your prostate cancer, your doctor may discuss different management options with you. It is also advisable to discuss the options with your partner, close friends, relatives, and other men with prostate cancer.