“Prostate cancer is an old man’s disease.” “You’re more likely to die WITH prostate cancer than FROM it.” When you put them together, you get the picture that most prostate cancer doesn’t even start until a man is in his late 60s, and it’s so slow-growing that he’s going to die of other causes.

We now know that to be a very oversimplified picture of PCa. Here are some facts:

• According to the American Cancer Society, about 60% of cases are diagnosed in men 65 or older.
• At least 10% are diagnosed in men younger than 55.^[i]
• Prostate cancer incidence is increasing at a rate of 3% annually.^[ii]
• The increasing trend is confined to distant-stage disease in men younger than 55 years and to regional/distant-stage disease in men aged 55–69.^[iii]
• Over the past decade of data, distant-stage disease has increased by 2.6% annually in men younger than 55 years, 6.0% annually in men aged 55–69 years.^[iv]
• Younger men diagnosed with high risk or advanced stage disease have higher rates of cancer-specific mortality (dying from their prostate cancer).^[v]

These facts offer a different view. Prostate cancer is being diagnosed more frequently in younger men. It is being found at more advanced stages in them. They are at greater risk of cancer-specific death. In fact, prostate cancer in younger men may be biologically different from that in older and elderly men.^[vi]

Prostate cancer growth rates

It is neither feasible nor ethical to watch a newly diagnosed prostate cancer tumor grow in a patient and time it while it’s happening. As for laboratory studies, in 2012 Georgetown University researchers found a way to keep prostate cancer cells alive in the lab indefinitely, allowing them to proliferate (duplicate themselves unchecked). This is good for biologic research but it doesn’t reflect actual tumor behavior inside a man’s body, where it is taking advantage of the essential body’s resources.

A recent journal article reported efforts to use MRI-based tumor measurements between time points to model tumor growth rates. The authors, an expert team out of University College London, enrolled 145 patients on MRI-monitored Active Surveillance for localized prostate cancer. Their goal was to estimate “the natural trajectory of prostate cancer lesions starting at a single cell to clinical detectability (diameter ? 1 cm), with diameters estimated based on spherical volume.”^[vii] To achieve their aim, they used statistical probability models to track tumor behavior in actual patients.

“Clinical detectability” means feeling a prostate cancer tumor during a digital rectal exam (DRE or finger exam). At earliest clinical detection, it would likely be about the size of a pencil eraser (about 1 cm). Compare that to earliest detection on a powerful MRI magnet with an experienced radiological reader; it can be identified when it is the size of a grain of rice (about 3mm). Thus, the team was trying to predict how long it would take a single prostate cancer cell to become detectable on MRI.

Here is what the British team calculated:

Lesions [tumors] with Gleason 3 + 4 had faster volume doubling times than Gleason 3 + 3 lesions (mean = 3.5 and 5.2 years, respectively). On average, it would take 17 years for a lesion to grow from a single cell to an MRI-detectable size and an additional 12 years to reach a clinically detectable size. At age 50, 75% of lesions would remain undetectable by MRI.

Yet, another published timeline based on a statistical population model had different findings:

The model estimates the average delay time [time between tumor initiation and diagnosis]. In older men, the delay time can reach ten years duration, but men diagnosed prior to age 50 tend to have delay times under two years, with progressively shorter delays between tumor onset and clinical detection at the youngest ages.^[viii]

Although the MRI-detectable model points to a longer growth curve for prostate cancer (supporting the idea of a slow-growing disease), the authors acknowledge that many factors play a role in tumor behavior. That said, both studies affirm that prostate cancer diagnosed at a younger age, especially higher grade disease, has faster tumor growth.

Key takeaway – early detection saves lives

What’s the key takeaway from all this? At the Sperling Prostate Center, we consistently encourage early detection for every man. Now it’s clear why it’s especially important for younger men, since a tumor may grow more quickly in that age group.

Early detection begins with annual PSA screening, starting at the American Cancer Society (ACS) recommended ages based on personal factors. While it is not specific only for prostate cancer, it is the earliest hint that something unusual is going on. If a test result is suspicious, the next step should be a multiparametric MRI to clarify the cause. This painless scan prevents overdetection and overtreatment.

Remember: early prostate cancer has no symptoms. Finding it at its earliest stages is when treatment is most successful, and when focal therapy with very few side effects is most likely to be an option. If you’re 40 or over, check out the ACS age guidelines. This may be the year you start PSA testing.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol. 2014 Jun;11(6):317-23.
[ii] Kratzer TB, Mazzitelli N, Star J, Dahut WL, Jemal A, Siegel RL. Prostate cancer statistics, 2025. CA Cancer J Clin. 2025 Nov-Dec;75(6):485-497.
[iii] Kratzer, Ibid.
[iv] Ibid.
[v] Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol. 2014 Jun;11(6):317-23.
[vi] Salinas, Ibid.
[vii] Smith H, Stavrinides V, Giganti F, Moore CM et al. Variation in prostate cancer growth rates in an MRI-based active surveillance cohort. Eur Radiol. 2026 Jan 16.
[viii] Salinias, Ibid.