Prostate Cancer in Younger Men: Navigating a Growing Concern
The rates of prostate cancer are higher in Australia than in most other countries around the globe.i The disease usually affects men above the age of 50, though a growing number of younger men are being diagnosed. In these situations, patients face unique challenges that healthcare professionals must be aware of in order to help them successfully navigate the treatment and management process.
Additional challenges
Men under the age of 50 have an array of different challenges compared to their older counterparts due to their stage of life. For example, they are more likely to have dependent children, substantial financial responsibilities and broad ambitions for the future. A prostate cancer diagnosis could have a significant impact on a young man’s everyday life, impacting everything from their social interactions to potential romantic partners. All of these pressures and concerns will likely influence their treatment decisions as well.ii
Disease presentation
Prostate cancer may also present differently in younger men. Researchiii has found that prostate cancer in men under 50 is commonly a lower grade and stage compared to that presenting in older men. Another studyiv found that the condition had less aggressive clinical characteristics in the under-50s – although these patients were more likely to undergo radical prostatectomy. All of these factors will need to be considered when formulating a treatment plan with a younger man diagnosed with prostate cancer.
Quality and length of life
As with any systemic health condition, a patient’s quality of life is an important factor with regards to the management and treatment techniques selected. A recent studyv evaluated patients 15 years post-diagnosis to find that all participants reported a lower quality of life than men without prostate cancer. It was also found that those treated with radical prostatectomy had the lowest quality of life, especially with regards to poorer sexual outcomes.
Although this study considered participants aged 50-85 (at their 15-year follow-up), and therefore didn’t entirely represent the younger generation of prostate cancer sufferers, its findings should be considered when exploring treatment options for the under 50s.
Another way of improving quality of life for those diagnosed with prostate cancer is by opting for treatment with Irreversible Electroporation (IRE). The next generation of focal ablative therapy, this technology uses non-thermal energy to disrupt cellular homeostasis and initiate the death of cancer cells. It is unique in that it leaves connective tissue unaffected, reducing the risk of damage to vital nerves and blood vessels, unlike thermal modalities, promoting the reduction of discomfort and reducing the risk of complications and recovery times for patients. The AngioDynamics NanoKnife, available from Getz Healthcare, is the first surgical ablation system to utilise this innovative technology.
Another concern is life expectancy. Men aged 50 who receive a prostate cancer diagnosis are more likely – by 60% – to die prematurely before the age of 80, compared to men diagnosed at 70.vi This is attributed to the fact that the cancer has more time to progress.
Early detection remains key
No matter how old a man is, early detection of prostate cancer is important for effective management. Though population-based screening is not recommended for asymptomatic men, it is important that men have access to PSA screening where symptoms present and they understand the potential risks involved.vi You can read more about the controversies associated with screening, as well as the treatment options available for prostate cancer, in our blog "'Early Detection and Treatment of Prostate Cancer – Opportunities and Controversies".
i ManUp For Prostate Cancer. Prostate Cancer. https://manupaustralia.org.au/prostate-cancer/ [Accessed January 2024]
ii Prostate Cancer Foundation of Australia. Treating prostate cancer in younger men. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.pcfa.org.au/media/306077/2014_pcfa_younger_men_2_treatment.pdf [Accessed January 2023]
iii Macneil J, Maclean F, Delprado W. Pathological Characteristics of Prostate Cancer Occurring in Younger Men: A Retrospective Study of Prostatectomy Patients. Urology. 2019 Dec;134:163-167. doi: 10.1016/j.urology.2019.08.048. Epub 2019 Sep 18. PMID: 31541648.
iv Kinnear NJ, Kichenadasse G, Plagakis S, O'Callaghan ME, Kopsaftis T, Walsh S, Foreman D. Prostate cancer in men aged less than 50 years at diagnosis. World J Urol. 2016 Nov;34(11):1533-1539. doi: 10.1007/s00345-016-1824-4. Epub 2016 Apr 12. PMID: 27072535.
v Mazariego C G, Egger S, King M T, Juraskova I, Woo H, Berry M et al. Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study BMJ 2020; 371 :m3503 doi:10.1136/bmj.m3503
vi PD Baade, SK Steginga, JF Aitken, CB Pinnock. Communicating prostate cancer risk: what should we be telling our patients? Med J Aust 2005; 182 (9): 472-475. || doi: 10.5694/j.1326-5377.2005.tb06790.x