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Prostate Cancer in Younger Men

Medically Reviewed by Michael W. Smith, MD on May 18, 2021

Prostate cancer is more common in older men than younger men. But more often, younger men are being diagnosed with prostate cancer, which is also known as early onset prostate cancer.

Is Early Onset Prostate Cancer Common?

The average age for a first prostate cancer diagnosis is 68. In the U.S., about 10% of men newly diagnosed with prostate cancer are under 55. You may also develop prostate cancer when you’re much younger, in your teens or as a young adult, though this is extremely rare.

Around the world, there’s been an increase in early onset prostate cancer in men between 15 and 40 years old.

Experts aren’t sure why there’s an increase. It may be related to certain risk factors. It may also be because of changes in how it’s diagnosed. Screenings are more frequent, and there’s more awareness that prostate cancer can happen in younger men.

What Causes Early Onset Cancer?

It’s not yet clear why younger men get prostate cancer.

There seems to be a link between your genes and early onset prostate cancer. Researchers need to do more studies to see if things like obesity, physical activity, HPV infection, and exposure to things in the environment like cancer-causing agents play a role.

How Early Onset Prostate Cancer Is Different

Doctors think the type of prostate cancer you get when you’re younger may be different from prostate cancer with a later onset and are doing research to learn more.

If you get a prostate cancer diagnosis when you’re younger, it’s more likely to be in a more advanced stage. You’re also more likely to have a lower rate of survival than middle-aged men and older men would.

In the U.S., the average 5-year survival rate for prostate cancer is between 95% and 100% for men ages 40-80.

For younger men, the 5-year survival rate is lower. For men ages 25-34, it’s 80%. For men ages 20-29, it’s 50%. For men ages 15-25, it’s 30%.

Treating Prostate Cancer in Young Men

There are several treatment options for early onset prostate cancer. Your treatment will be based on your age, stage, symptoms, and overall health.

Watchful Surveillance

With older men, doctors may recommend waiting to treat prostate cancer to see if it gets worse to avoid side effects that affect quality of life. This is called active surveillance. A doctor monitors the cancer through PSA tests, exams, and biopsies, and chooses to treat it if it grows.

But this is extremely rare. Your doctor will more likely recommend starting treatment right away because as a younger man, you have many years ahead of you. Watchful surveillance isn’t common for younger men, even those with stage I prostate cancer.

Radical Prostatectomy

If the cancer is localized, which means it hasn’t spread beyond your prostate, you may have surgery called radical prostatectomy to remove it before it spreads.

During surgery, your doctor removes your prostate, including your prostate gland and surrounding tissues. Your doctor may also remove your pelvic lymph nodes. Your surgery may be open, laparoscopic, or robot-assisted.

Radiation Therapy

Radiation therapy uses X-rays to destroy cancer cells. Radiation can be used to target the cancer in your prostate, or other areas if it’s spread to different parts of your prostate area.

There are two types: external beam radiation, which a technician applies outside of your body, and brachytherapy, which a clinician puts into your prostate.

Your doctor may recommend radiation after surgery if they see that the cancer has spread beyond your prostate during surgery. They may also recommend it if your PSA level is still detectable a few months after your surgery.

Hormone Therapy

Testosterone helps prostate cancer cells grow. Hormone therapy stops your body from making testosterone or stops it from getting to cancer cells.

Your hormone therapy may involve medications that stop your body from making testosterone, medications that block testosterone from reaching cancer cells, or other medications that help control testosterone.

Your doctor may recommend hormone therapy if your PSA level or Gleason scores show that you have a higher recurrence risk. Hormone therapy is often used alone for stage IV prostate cancer.

Your doctor may also recommend combining it with chemotherapy, radiation therapy, or surgery, which is much less common.

Chemotherapy

Your doctor may recommend chemotherapy if your prostate cancer has spread to other parts of your body or if hormone therapy doesn’t work. Chemotherapy slows the growth of cancer cells.

Chemotherapy involves anti-cancer drugs that travel through your blood to reach cancer cells. You may have the drugs injected into a vein, or you may take them by mouth. You may have chemo in cycles, with a period of treatment and then a period of rest. It’s often 2-3 weeks per cycle.

Chemotherapy slows the growth of cancer, helps you live a longer life, and may help with symptoms.

Immunotherapy

If your prostate cancer spreads, or if you have advanced prostate cancer without many symptoms but it’s not responding to hormone therapy, your doctor may recommend immunotherapy.

Immunotherapy teaches your immune system to recognize and destroy cancer cells.

You may have a cancer vaccine called sipuleucel-T (Provenge), which boosts your immune system to specifically target and attack prostate cancer cells. It doesn’t stop prostate cancer from growing but does seem to help you live longer.

Targeted Drug Therapy

With targeted therapy, your doctor uses drugs to attack weaknesses in cancer cells.

The drugs don’t damage your normal cells, but they interrupt cancer cells from growing, dividing, repairing themselves, or interacting with other cells.

With targeted drug therapy, you may take pills twice a day by mouth.

Combination Treatments

Your doctor may recommend a combination of treatments, like radical prostatectomy and external beam radiation, or brachytherapy and external beam radiation.

Side Effects

Prostate cancer treatment often causes side effects that can be concerning for younger men, such as:

  • Problems getting and keeping an erection
  • Low sperm production
  • Leaking urine
  • Changes in your penis size

Infertility is common. It happens after surgery because a surgeon removes your prostate and seminal vesicles, which carry sperm from your urethra and out your penis during ejaculation. Radiation also changes your semen and makes it harder for your semen to transport sperm.

If you’re concerned about side effects, talk to your doctor. They may recommend these options:

Sperm banking. If you want to have children after your treatment, you can try storing your sperm before your surgery. Your medical team will freeze your semen (which has sperm in it) in liquid nitrogen. Later, they’ll thaw the semen so you can use it for artificial insemination. After this process, up to 50% of your sperm will grow back.

Your doctor may also be able to extract your sperm directly from your testicles. Your medical team may harvest it from your testicular tissue. Then they inject it into an egg, and if an embryo forms, they can put it into a woman’s uterine wall.

Nerve-sparing prostatectomy. Your doctor may try this procedure during surgery, which preserves the nerves on either side of your prostate. You need these nerves to have an erection. A prostatectomy isn’t always an option. Talk to your doctor to see if it may work for you.

Show Sources

SOURCES:

Cancer: “Prostate cancer in young men: An emerging young adult and older adolescent challenge.”

Current Urology: “Prostate Cancer: How Young is Too Young?”

American Cancer Society: “Chemotherapy for Prostate Cancer,” “Immunotherapy for Prostate Cancer,” “Initial Treatment of Prostate Cancer, by Stage,” “Targeted Therapy for Prostate Cancer.”

Johns Hopkins Medicine: “Fertility After Prostate Cancer Treatment.”

Mayo Clinic: “Stage 4 Prostate Cancer.”

Prostate Cancer Foundation of Australia: “Treating Prostate Cancer in Younger Men.”

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