P Ca in Young Men an Emerging Challenge

• 29 Jan 2020 10:54:50 AM
• |Onco Urology

Dear All,

We all presume that P Ca is a disease of old age and the incidence of this disease occurring in men below 55 years have been considered as Young and the incidence is much lower under 55 when compared to older age group.

In an article published in 2015, it is reported that the literature on prostate cancer contains < 30 reported cases of prostate cancer among men ≤ 40 years of age. But this figure may not be factual as more cases have been found in younger than 40 age group. There was an anecdotal case reported of P Ca in a two years old child long ago. Sahil Gupta* et al (2015) reported a case of P Ca in a 28 years old male. I have personally treated (not published) a patient of 19 years old with P Ca.

PSA level is generally lower in these patients due to poorly differentiated adenocarcinoma of prostate. So in poorly differentiated carcinoma, PSA level is not indicative of prostate cancer.

Patients diagnosed with high grade tumours (Gleason score of 8–10) at ages 35–44 are also at higher odds of succumbing to prostate cancer as compared to patients aged 65–74 years. Moreover a strong genetic component has been associated with early onset prostate cancer. Lange et al (2012) reported that men with early onset prostate cancer are more likely to have a greater num­ber of genetic variants, which are associated with an increased risk of prostate cancer, as compared to older patients.

Archie Blayer, Ronald Barr* et al (2020) studied ‘Prostate Cancer in Young Men: An Emerging Young Adult and Older Adolescent Challenge’ and an excerpt is provided below.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32498?referrer_access_token=cOiCNMGm1aLgJNTEkKbvbE4keas67K9QMdWULTWMo8NPTiVs2i71r1_b3rq1GbdQBWBBe-Vks8op0oqW8nmJ0Mb7wBTat7A3q7BoYoXwtk3sF8E5pKT3GZunAONqjepbNQNPBtZ_px5yPixTH-600Q%3D%3D

(Full article is available but cannot be downloaded)

‘Recent observations suggest that prostate cancer is increasing among young adults. This study investigated incidence and survival data among men <40 years of age with prostate cancer. Recent observations suggest that prostate cancer is an increasing disease among older adolescents and young adults. The SEER program and the Institute for Health Metrics and Evaluation Global Burden of Disease database were used for analysis. The authors found, worldwide, the incidence of prostate cancer has increased in all groups between ages 15 and 40 years and has increased globally at a steady rate averaging 2% per year since 1990. In the US, this age group was over six times more likely than older men to have distant disease at diagnosis. The 5-year relative survival rate in the US for men diagnosed between ages 40 and 80 years was between 95% and 100%. It was, however, 30% in those ages 15 to 24 years, 50% in those ages 20 to 29 years, and 80% in those ages 25 to 34 years’. The authors conclude that prostate cancer in older adolescent and young adult men is increasing in incidence and is more aggressive compared with prostate cancer in older men. Environmental factors such as obesity, physical inactivity, and substance exposure may be contributing.

This fact should be borne in mind when one encounters a patient with LUTS at an younger age group.

I am sure there will be many in our group who might have encountered P Ca in very young patients and it would be worth sharing it with all.

With warm Regards,

Venu

 

Comments(1)

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  Atul Kumar Khandelwal

  29 Jan 2020 09:49:19 PM

  I have seen two cases of carcinoma prostrate in young patients. Both patients father also had carcinoma prostrate. One patient's brother also had ca prostate managed by radical prostatectomy.