8 Things Younger Men Should Know About Prostate Cancer

Prostate cancer is known as a disease of older men, and that's largely true. The average age of prostate cancer diagnosis is 66, and about 60 percent of new cases occur in men 65 and older, according to the National Cancer Institute. Even so, rates are rising in men 55 and younger, who face different long-term risks. If you're a man in your mid-50s or younger, here's what to consider about prostate cancer, screening, treatment choices and prevention.

1. It Can Be More Aggressive

Cancer of the prostate gland -- which produces fluid contained in semen -- is the second-most common type of cancer in men. About 14 percent of men will be diagnosed with prostate cancer at some time in their lives, according to the National Cancer Institute, and about 2.8 million U.S. men are prostate cancer survivors. Fortunately, survival rates are very high, at 90 percent and above for all stages of cancer combined.

"There's very good data that most men die with prostate cancer rather than of prostate cancer," says Dr. Scott Tomlins, an assistant professor of pathology at the University of Michigan Medical School.

However, men diagnosed with prostate cancer at 55 or younger are more likely than others to eventually die from the disease itself, according to a May 2014 study in Nature Reviews: Urology, which found other differences in this age group.

Most men with early-onset prostate cancer are diagnosed with low-risk disease, the University of Michigan study found. But among certain types that strike at a younger age, tumors appear to grow more quickly and be more lethal.

2. Early Detection Recommended

Prostate cancer diagnosed in younger men "has a strong genetic component," the researchers found; and men with a family history of prostate cancer are known to be at higher risk of developing the disease.

"Certain genetic variants have been shown to be associated with high risk of prostate cancer," Tomlins says. "Variants in genes like BRCA2 or BRCA1 -- some of the same genes that put you at risk for breast cancer."

For men with average risk, discussions with doctors about prostate cancer screening should take place at age 50, according to the American Cancer Society. But men at high risk should consider screening at age 45. High-risk men include African-Americans or any man with a father, brother or son who was diagnosed with prostate cancer at an early age.

Men at even higher risk -- those with more than one close relative who had prostate cancer at an early age -- should consider screening when they turn 40.

3. Screening Tests Are Simple

You can be screened for prostate cancer in your doctor's office with a simple blood test for prostate-specific antigen. While a PSA level at or below 4.0 ng/mL has traditionally been considered normal, the American Cancer Society recommends yearly testing for men with a PSA of 2.5 or higher. A digital rectal exam, to detect abnormal areas or lumps in the prostate, may also be part of screening.

Similar to guidelines for breast cancer screening, there's some controversy around prostate cancer screening guidelines -- how often screening is needed, at what age to begin and whether routine screening is helpful for men at low risk. Ultimately, it's an individual decision -- and discussion -- between you and your health care provider.

"No one recommends that a man should be screened without understanding the benefits and drawbacks of screening," says Dr. Richard Wender, chief cancer control officer for the American Cancer Society. "Everyone agrees that routine screening without a discussion is not right and should not be done."

4. Symptoms to Notice

Usually, early prostate cancer doesn't cause any symptoms. With more advanced cancers, urinary problems such as a weak or slow stream, or the need to urinate more often, particularly at night, may be signs. Blood in the urine is another symptom, as is erectile dysfunction. However, there could be a variety of other causes of these problems, like benign prostatic hyperplasia, or enlarged prostate, a noncancerous condition that's common in older men.

Bone pain in the hips, back, ribs and other areas can indicate prostate cancer that has spread. Numbness or weakness in the legs and feet are also possible symptoms. Talk to your health care provider if any of these issues arise.

5. Baldness Tied to Risk?

Men with male-pattern baldness may have a slightly higher risk of developing fatal prostate cancer compared to men with a full head of hair, according to a recent study in the American Journal of Epidemiology. The increased risk was 56 percent for men with any degree of balding, although the most conservative estimate from the study would be a 2-percent increased risk, according to study author Dr. Michael Cook, an investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute.

While that study did not make any age-related conclusions, Cook points to a previous study, published last year in the Journal of Clinical Oncology, in which men recalled how bald they were at age 45. Male-pattern baldness was associated with about a 40 percent increase in the relative risk of aggressive prostate cancer, compared to men with no balding at 45 years old.

Much more follow-up research is needed to better understand the possible overlap between hair loss, male-hormone levels and disease risk, Cook emphasized in an email. "Men of any age and any balding status need not be additionally concerned about their individual risk of prostate cancer," he concluded.

6. Treatment Now May Help Later

Finding prostate cancer at a younger age, even slow-growing varieties, could tip the balance in making treatment choices. "If you diagnose the type of cancer that appears to be non-aggressive in a 50-year-old man, it's likely that that particular cancer, as it appears at that moment, does not need to be treated," Tomlins says. "We know from the behavior of those tumors that that sort of tumor has almost no chance of spreading outside the prostate. However, if you take those men and follow them over 20 years, the men that get treated do better than the men that don't."

Surgery and radiation, either external or internal, are treatment mainstays for prostate cancer. Other standard treatments include chemotherapy, hormone therapy and biologic therapy.

7. Watchful Waiting Can Work

With the latest medical technology, called multiparametric MRI, doctors can follow patients with early-onset prostate cancer with much more precision. "It allow a urologist to visualize lesions in the prostate when they do a biopsy," Tomlins says. "It also allows them to track where the biopsy went. And if they go back a year later, to try and biopsy that same area."

Such medical advances have opened up options for patients with less-aggressive cancer, Wender says, including the option for active surveillance, also known as watching and waiting. "Ten years ago, the thought that you could get a cancer and watch it closely just seemed outrageous," he says. "It's not outrageous today. We actually know that for many men, active surveillance -- close monitoring with technologies like the new MRI that make it more accurate to know whether it's progressing -- is a very good choice for many men with early prostate cancer."

Shared decision making -- with patients getting the information they need to consider and discuss screening and treatment choices that incorporate their personal values -- is part of the process.

8. Lifestyle Is Key

In terms of prevention, Wender says, "The more important lesson is for all of us to be concentrating on the things that we know reduce overall cancer risks -- being physically active, trying to maintain a healthy weight and choosing healthy foods."

Unlike heart disease, in which a specific type of diet has been identified as preventive, Wender says, less is known about exactly which foods matter most for avoiding prostate cancer. "The good news is all the things that are good for preventing heart disease are good for preventing cancer, too," he says. That, he adds, includes eating a healthy diet with plenty of fruits and vegetables. "Whether we know the perfect diet for preventing prostate cancer, we know it's the best diet for reducing overall cancer risk."

Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.