Prostate cancer in younger men

Information Note

Prostate gland is a part of the genitourinary system. Located below the urinary bladder and surround the urethra. It is about the size of a walnut but it grows with age. Apart from age related prostate enlargement, few patients can have disordered, uncontrolled and abnormal proliferation to form tumors. This happens due to some kind of mutations in the cells, and is called prostate cancer then, one of the most commonly detected cancers in men.

September is the month of Prostate Cancer Awareness. Bringing prostate cancer into the spotlight and spread knowledge in terms of early detection and treatment, we speak to Dr Rajesh Kumar Reddy Adapala, Uro Oncologist at the Asian Institute of Nephrology and Urology (AINU).

How common is prostate cancer in young men?

It is primarily a disease of the elderly with more than three quarter of the cases occurring in men above 65 years of age. It is relatively less common in young men under 50 years, accounting for about 2–10% of all prostate cancer cases. Incidence is raising though. However, when it does occur at a younger age, it’s usually more aggressive. Hence awareness and timely detection is the need of the hour.

What are important risk factors?

Age. As already discussed, Age itself is biggest risk factor for prostate cancer Since the chances of developing this cancer increase steadily with advancing years.

2. Genetic predisposition: Certain genetic mutations acan increase the risk of prostate cancer
3. Family history have two- to three-fold increase in the risk of prostate cancer, especially if genetic mutations are involved
4. Race and ethnicity: African-Americans are more predisposed to get prostate cancer when compared with other ethnicities.
5. Metabolic syndrome: It is the combination of Obesity, high sugar levels, high blood pressure and excess cholesterol.
6. Are there specific causes of prostate cancer at a young age?

There are certain risk factors for prostate cancer in youngsters in specific. Genetic causes are usually the primary reason. Mutations in genes such as BRCA1, BRCA2, HOXB13, and ATM significantly increase the risk of developing prostate cancer at a younger age. Inherited cancer syndromes like Lynch syndrome can also contribute. If family history and genetic mutations are involved, risk increases further. Apart from genetic and hereditary factors, Lifestyle issues like obesity, sedentary lifestyle and unhealthy diet may accelerate onset in men who are genetically predisposed.

How does family history raise risk?

Having a close relative with prostate cancer significantly raises one’s risk. For example, a man with a father or brother who had it is about twice as likely to develop it himself. The risk increases even more when multiple close relatives are affected, sometimes by as much as four to five times. Family history is also linked with earlier onset and more aggressive forms of the disease.

What is the role of genetics in prostate cancer?

Genetics plays a central role, especially in early-onset cases. Mutations such as BRCA2 not only raise the risk of developing prostate cancer but are also associated with more aggressive disease. Other mutations like BRCA1, HOXB13, and mismatch repair genes found in Lynch syndrome also contribute. Men from families with multiple cases of prostate, breast, ovarian, or pancreatic cancer are advised to consider genetic counseling and testing.

Among the genetic factors BRCA2 mutations and lynch syndrome greatly increase the risk, often at a younger age and with aggressive features. BRCA2 mutations also raise the risk of male breast cancer, pancreatic cancer, and melanoma, and in women, breast and ovarian cancers. Lynch syndrome, caused by mismatch repair gene defects, elevates the risk of prostate cancer as well as colorectal, endometrial, ovarian, gastric, and urinary tract cancers.

What tests help detect this cancer in the early stage?

As per the recommendations, men should get their screening done at the age of 50 years and older.  If there is a positive family history, screening is recommended a bit earlier i.e from the age of 45 years. Once your Urologist suspects prostate cancer, he will ask for MRI test to see the exact location of the tumour, any local invasion to surrounding area and to assess the operability. This is followed by prostate biopsy. The lesion is exactly targeted  and biopsied with the help of TRUS, i.e a specialized ultrasound probe which is inserted into the rectum. Once cancer is confirmed by biopsy, further metastatic work-up is done by PSMA (Prostate specific Membrane Antigen) PET CT scan to look for spread of cancer to any other distant organs.

Can early-onset prostate cancer be prevented or detected early?

There is no guaranteed way to prevent prostate cancer, but lifestyle choices such as eating a balanced diet, exercising regularly, maintaining a healthy weight, and avoiding smoking may reduce risk. Routine PSA screening for all young men is not recommended. However, men in high-risk groups, such as those with a strong family history, known genetic mutations, or African ancestry, should consider starting PSA screening earlier, around age 40–45. Combining PSA with MRI and genetic testing improves early detection in these men.

We come across different sets of people.

A 46 years man presented to us with borderline PSA elevation during his health check. Biopsy showed only one small focus of tumour of very low grade. We actually kept that patient under surveillance with periodic PSA checks,  to avoid / postpone treatment related side effects and better quality of life. Since the tumor is at very low risk, the chances of progression is also negligible. This is called active surveillancde.

Another patient got PSA check-up at the age of 45 years, as his father also had same cancer. His disease was in first stage but the grade was aggressive type. Hence we did Robotic radical prostatectomy, i.e surgical removal of cancerous prostate with robotic assistance. The robot provides 3D vision and flexible movements of robotic instruments. This facilitates better surgical dissection with excellent precision.  Small nerve fibers around the prostate which are responsible for urine control and potency, can be preserved during the procedure. We usually call as nerve sparing prostatectomy.

We also treated one 43 years male with locally advanced prostate cancer with spread to lymph nodes in pelvis and abdomen. This was not amenable for surgery. Hence patient was offered hormone therapy followed by radiation.