Prostate cancer has traditionally been described as a disease of the “aging male”. This designation would be correct since the peak age range of diagnosis in Jamaica is 75-80 years. Data from the United States suggest that most men diagnosed with prostate cancer are between the ages of 65 and 74 years. However, it is still possible to be diagnosed with prostate cancer at an early age. “Early-onset prostate cancer” is defined as prostate cancer that occurs before 55 years. It is thought that genetic factors are responsible for the disease in these young men. Approximately 10 per cent of men diagnosed with prostate cancer have early onset disease. Analysis of data from patients with prostate cancer managed at the University Hospital of the West Indies, Mona reveals that nine per cent of men presenting have early-onset prostate cancer. Internationally, it is thought that the prevalence of early-onset prostate cancer is increasing. This may be because screening for prostate cancer is becoming more widespread in many countries.
There is a term called “hereditary prostate cancer”. Five to 10 per cent of cases of prostate cancers are hereditary and the increased risk tends to run in families. Men with a father or brother with prostate cancer are twice as likely to develop prostate cancer as men with no affected relatives. The risk increases with increasing number of affected relatives, such that men with two or three first-degree relatives affected have a five-fold and 11-fold increased risk of prostate cancer, respectively. Hereditary prostate cancer is typified by the familial clustering of at least three first-degree relatives with the disease, or two relatives diagnosed below the age of 55 years. Mutations in certain genes, for example the HOXB13 genes may be associated with this type of prostate cancer. The BRCA2 gene may sound familiar because it also increases a woman’s risk for breast cancer. It is therefore important for a man to know his family history of diseases such as breast and prostate cancer as this may ultimately affect his risk of getting the disease.
Several studies have been done to determine if men with early onset prostate cancer have a better outcome, i.e. survival, than older men. The results are conflicting. Data from the United States (US) from a large nationwide registry suggests that men with early-onset prostate cancer have a good outcome. This may be because most men in the US diagnosed with prostate cancer have early stage disease and are offered curative treatment resulting in high survival rates. In addition, younger men may be more likely offered aggressive treatment and have less comorbidities that would complicate treatment. In Jamaica, men with early-onset prostate cancer treated at the University Hospital of the West Indies, although presenting commonly with advanced disease,a had similar outcomes as older men.
The available information on early-onset prostate cancer suggests that it is an important entity. It must be therefore emphasised that men should begin screening for prostate cancer annually at age 40 years. Prostate cancer presents with no symptoms at an early stage and men should not delay in having their screening done. The ideal time for diagnosis of the disease is early in its natural history. It is important to have family conversations about health and disease, particularly where risk may be increased. Genetic tests are available that may be useful to direct treatment decisions and manage risk.
Dr Belinda Morrison-Blidgen is consultant urologist at the University Hospital of the West Indies and senior lecturer and head, Division of Urology, University of the West Indies