THE FREQUENCY OF CARCINOMA AND INTRAEPITHELIAL NEOPLASIA OF THE PROSTATE IN YOUNG MALE-PATIENTS

The incidence of clinically detected prostate cancer is increasing wit h more frequent diagnosis in younger male patients. Whether this repre sents a genuine increase in incidence or earlier detection is not clea r. To understand better the evolution and early changes of prostate ca ncer we evaluated 152 prostate glands from young male patients 10 to 4 9 years old. Of the prostates 98 were from African-Americans and 54 we re from white patients. Prostatic intraepithelial neoplasia was identi fied in 0%, 9%, 20% and 44%, and small foci of histological cancer in 0%, 0%, 27% and 34% of the male patients in the second, third, fourth and fifth decades of age, respectively. The majority of the cases of p rostatic intraepithelial neoplasia were of low grade. High grade prost atic intraepithelial neoplasia, found in 5 prostates, was first identi fied in the fifth decade. All 5 cases occurred in prostates containing histological carcinoma. Incidental carcinoma was detected with a simi lar frequency in white and black patients. The cancerous foci were of similar size with a tendency for cancer in black patients to be multif ocal, particularly in those in the fifth decade. We conclude that pros tatic intraepithelial neoplasia and histological cancers are surprisin gly common in young male patients of both races. The evolution of pros tatic intraepithelial neoplasia and focal histological cancers is not clear but it appears to present several decades earlier than clinicall y detected carcinoma. The natural history of prostate cancer must enco mpass many more years (decades) than has been previously realized. In addition, the initiating events leading to clinically relevant prostat e cancers likely occur at a remarkably young age.