Prostate cancer: Not just an older man’s disease

Prostate cancer, aka the “silent killer”, has always been known as an older man’s disease. Being the second most common cancer among men in the United States, prostate cancer occurs mainly in older men. The average age of diagnosis is about 66, and about six in ten prostate cancer cases are diagnosed in men age 65 or older, according to the American Cancer Society.

It is the second leading cause of cancer death in American men; about 1 in 38 will die from it. But what many people are unaware of is that prostate cancer is not just an older man’s disease. Men younger than 50 (as young as 40, and sometimes younger) can get prostate cancer too.


More Younger Men Diagnosed with Prostate Cancer

Did you know that number of younger men diagnosed with prostate cancer has increased nearly six-fold in the last twenty years? What’s more alarming is that for younger men, the disease is often much more aggressive. Prostate cancer typically affects men in their 60s, 70s and older, and is often slow-growing. For this reason, older men are likely to die of causes other than prostate cancer, rather than of prostate cancer. But when younger men are diagnosed with prostate cancer, it is likely because they have developed a tumor that is growing quickly and aggressively.

Peter Latos Died at Age 48

Peter Latos was a patient of mine who came to me after being diagnosed with prostate cancer at age 42. Peter actively monitored his health and sought to have a PSA test at age 40, only to be told that it was not recommended because he was simply too young. He then went for a routine stress test with his cardiologist who ran a serious of blood tests, including a PSA test. Peter’s PSA level was about 14 ng/mL and was referred to a urologist who initially diagnosed with prostatitis. (For the average healthy man, a normal PSA level falls somewhere between 1.00-4.00 ng/mL.) He was given a course of antibiotics as treatment, which slightly reduced his PSA, but only to a level that was still very high. A biopsy should have been performed at this point, but never was.

Peter had his PSA tested again about one year later and by that time, his PSA level had shot up to 60 ng/mL. A prostate biopsy confirmed that he had stage 4 prostate cancer, meaning the prostate cancer had already spread to the lymph nodes, other organs, and the bones. Doctors told him he had just six months to live and that his options for treatment included chemotherapy, radiation, and hormones. This was not good enough for Peter. He then came to me to have his prostate removed and I performed a radical robotic prostatectomy on Peter just one week later. While many doctors may advise against this given his advanced disease, Peter wanted to put up a fight against this disease and I wanted to help him do that. He fought his prostate cancer successfully for five years. Unfortunately, his illness took a turn for the worse and Peter died at just 47 years old.

The story of Peter Latos is just one of many examples of young men who are diagnosed with aggressive prostate cancer. Not all young men diagnosed with prostate cancer are guaranteed to lose their life as a result, but the risk is much higher because of the nature of the disease in younger men. If Peter had been tested just a few years earlier, he may still be alive today.


PSA Blood Test Screening

Because of the current PSA guidelines established by governmental agencies like the US Preventive Services Task Force, many doctors or urologists do not recommend PSA tests until a man is in his 50s. In fact, the USPSTF recommends against PSA screening completely, claiming there is not enough evidence to support the benefits of the test. Other agencies or organizations recommend that men begin testing their PSA at age 50 or 55. However, this is simply not good enough.

What I want men to know:

1.    Get a baseline PSA test starting at age 40.

Men should have a baseline PSA test starting at age 40. There is no harm in knowing your numbers. PSA results should be discussed with an experienced specialist who can guide you in the right direction about how to follow up and what to be aware of.  

2.    Know your family’s medical history for prostate cancer.

Knowing your family’s medical history is just as important. Men who have a brother or father with a history of prostate cancer are twice as likely to be diagnosed with the disease. For younger men, the risk is even higher if they have multiple relatives with a history of prostate cancer. This should also be discussed with the same experienced specialist who checks your PSA level.

3.    African-American men have the highest risk for prostate cancer.

African-American men should especially be aware of prostate cancer. African-American men are 60 percent more likely to develop prostate cancer and are 2.5 times more likely to die from it. African-American men are also diagnosed at a younger age (about 3 years younger) and are more likely to have high-grade or aggressive tumors.

Men should also educate themselves on the PSA trend and the PSA velocity. The PSA trend is the history of any changes in the PSA level. It’s important to track whether the PSA level continues to rise or remains stagnant over time. A Northwestern research study showed that about 70 percent of men who had rising PSA levels and negative biopsies were eventually diagnosed with prostate cancer.

The PSA velocity is the trend of the PSA level over a number of years. It is the rate of change, or speed, at which the PSA rises. The speed at which the PSA rises is helpful in predicting if prostate cancer is present. For example, if the PSA doubles within a year, as opposed to remaining stagnant over two years, there is a higher chance that prostate cancer is present.

Prostate cancer can truly be a “silent killer.” There are usually no symptoms present until the disease is in an advanced stage. This is why early detection is key. Screening for prostate cancer is essential in order to find the disease early. Detecting prostate cancer early allows men to have more treatment options and more effective treatment in general. When prostate cancer is discovered in the early stages when it is still confined to the prostate gland, the cure rate is almost 100 percent.

Early Detection Methods for Prostate Cancer:

  • PSA (prostate-specific antigen) blood test. This is the primarily test used to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen in the blood. PSA is a protein produced in the prostate gland (a walnut-sized gland that sits directly beneath the bladder). While a high PSA level may indicate prostate cancer, the PSA test is not specific for prostate cancer. A high PSA may also indicate other prostate conditions, such as an enlarged prostate (BPH) or prostatitis (prostate infection).
  • Digital rectal exam (DRE). A DRE is usually done in conjunction with the PSA test. It is done to check for any abnormal growths or tumors on the prostate gland.
  • Prostate biopsy.
    • Trans-rectal ultrasound prostate biopsy. Trans-rectal ultrasound uses high-frequency waves to produce images of the prostate gland, which helps the urologist collect tissue samples from suspicious areas of the prostate gland.
    • MRI-guided prostate biopsy. A urologist uses MRI to produce images of the prostate gland, which helps him directly target suspicious lesions on the prostate from which tissue samples are collected. MRI-guided prostate biopsies are more accurate in detecting prostate cancer and can help reduce repeat biopsies in patient who have high PSAs and negative biopsies.
  • PCA3 urine test. A urine test that can help detect prostate cancer. This is a newer test and is to be used as a supplement, not by itself. It is not a replacement for the PSA test. The higher the PCA3 level, the most likely prostate cancer is present.
  • The story of Peter Latos was very unfortunate. He is one of many other men who have been and will be diagnosed with prostate cancer younger than 50. He did not have to die from prostate cancer, and neither do you. Get screened early.