Advanced prostate cancer poses a deadly paradox for younger men (aged 35 to 44 years). Younger men diagnosed with advanced prostate cancer will have a shorter remaining life span than older men who develop the disease, despite the fact that in general younger men have a much lower risk of dying from prostate cancer.

Daniel Lin, M.D., of the University of Washington, is studying this paradox. Dr. Lin is specifically interested in the mechanisms that shorten the lifespan of younger men with advanced prostate cancer, but do not have a similar effect in older men. His research utilized data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database.

Dr. Lin has concluded that increasing numbers of younger men are being diagnosed with prostate cancer, likely because of intense PSA screening regime we have in the United States. The ten-year survival rate, from diagnosis of all prostate cancers to death, for young men is better than for older men. Additionally, at diagnosis, younger men usually are found to have less aggressive forms of prostate cancer, again probably attributed to the intense, early PSA screening. However, they did find that younger men if diagnosed with advanced prostate cancer have shorter expected life spans when compared to older men with similar forms of advanced prostate cancer.

From this data pool (SEER) his study identified 318,774 men diagnosed with prostate cancer between 1988 and 2003. Dr. Lin was unable to explain why younger men die earlier from advanced prostate cancer than older men do, but he theorizes it was related to the type and strain of prostate cancer. He stated that perhaps advanced prostate cancer found in younger men is simply biologically more aggressive.

The acknowledgment that younger men diagnosed with advanced prostate cancer are at a higher risk for death is important. It clearly signals that immediate aggressive treatment in these younger men is vital for their survival. It also signals that additional studies (money) are needed to understand why younger men have a shorter lifespan when faced with advanced prostate cancer. Earlier detection of prostate cancer in younger men is important, especially in cases where they are found to have advanced prostate cancer. Early detection is also important to stop the progression from localized disease to systematic disease in younger men.

CANCER; Published Online: May 22, 2009 (DOI: 10.1002/cncr.24324)

Joel T Nowak MA, MSW