Early onset prostate cancer: predictors of clinical grade

Prostate cancer is typically a disease of elderly men and, therefore, it has not been well characterized in those affected at a young age. With the advent of serum prostate specific antigen testing, we are able to detect prostate cancer in young men even in the absence of symptoms. We studied a large group of early onset prostate cancer cases to illustrate the clinical presentation of men with early onset prostate cancer and to determine the effect of family history on Gleason grade as a reflection of prognosis.

All study participants were enrolled in the University of Michigan Prostate Cancer Genetics Project. Enrollment criterion of the Prostate Cancer Genetics Project includes a diagnosis of prostate cancer at age 55 years or younger. Descriptive statistics and logistic regression were used to characterize early onset prostate cancer and assess the associated prognostic factors.

The study group was comprised of 257 men with prostate cancer diagnosed at age 55 years or younger. Median age at diagnosis was 51 years (range 34 to 55) and almost half of the participants reported a negative family history of prostate cancer. In logistic regression analysis having an affected father, an affected first-degree relative or an affected relative of any relation was each a statistically significant predictor of well differentiated (Gleason 6 or less) compared to moderately and poorly differentiated prostate cancer (Gleason 7-10) after adjusting for confounding variables. Men with an affected relative were nearly twice as likely to have well differentiated prostate cancer compared to men without affected relatives.

Family history appears to predict the development of well differentiated tumors independently. In our study men with no family history of prostate cancer had higher grade tumors, which are associated with a more serious prognosis. Future studies of early onset prostate cancer should be directed toward identifying additional risk factors that may be relevant for men without a family history of the disease.