Clouded in the murkiness of the debate surrounding the use of the PSA test is an increasing escalation of younger men (under the age of 50 years) being diagnosed with advanced prostate cancer. We know that there has been escalating incidence rate (IR) of prostate cancer PC noted in the last two decades. Many have attributed this IR to the more common use of PSA testing for early PC detection.
Researchers performed a study to compare the relative and absolute rates of detection of early and advanced PC in younger males under the age of 50 and to examine if early cancer was the only contributor to the change in this group.
They used frequency and rate sessions on demographics and PC characteristics comparing among Non-Hispanic White (NHW), African-American (AA), Hispanic (H), US Asian/Pacific Islanders (A/PI) and American Indians/Alaskan Natives (AI/AN) using SEER*Stat. They then used the IR and stage at diagnosis trends of subjects diagnosed under the age of 50 years.
They found that a total of 22,227 cases of PC were reported under the age of 50 years at diagnosis in SEER database from 1973-2010. About 77% were in NHW, 12% in AA, 6% in Hispanics, 4% in A/PI and less than 1% in AI/AN. Table below reflects our results.
They found that IR of PC increased significantly in men under the age of 50 years in the last decade. However stage breakdown did not change significantly. This implies that incidence of advanced stages prostate cancer escalated in parallel with early stages.
This increase can’t be fully explained by the use of PSA screening.
The question then becomes why have we seen this increase? Possibly there are some unknown epigenetic, environmental or socioeconomic factors contributing to this increased risk of advanced prostate cancer in younger men. . Relative increase in IR was especially high in S Asian/Pacific Islander population (by 125%) with a trend towards increase of advanced stage cancer share (by 3%). Further studies into PC risk factors are warranted.
J Clin Oncol 32, 2014 (suppl; abstr e16030); Uladzislau Naidzionak, Katsiaryna Ivanova, Akm Mosharraf Hossain
Joel T. Nowak, M.A., M.S.W.