Should men in their 20s worry about prostate cancer?

Question

Hello doctor,

I am 24 and have been having some urinary symptoms for about two months now. I have to go frequently at night, sometimes have a weak stream, and once I noticed a very slight amount of blood in my urine, which went away on its own.

I went to a urologist, and he said my symptoms are probably not prostate-related at my age and ordered a urine culture. However, I keep reading that prostate cancer can happen in young men in rare cases, especially if there is a family history.

My dad was diagnosed with prostate cancer at 52, and his brother also had it. So my question is:

Should men in their 20s worry about prostate cancer at 24, given a strong family history?
Should a PSA test be done even at this age?
I feel the doctor may have dismissed my concern too quickly. What other conditions could cause these symptoms in someone my age?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern, especially with your strong family history, but even with a father and uncle affected, prostate cancer is still extremely unlikely at 24.

Family history can increase your lifetime risk, but prostate cancer in someone your age is very rare. In this age group, urinary symptoms such as frequency, a weak stream and even a brief episode of blood in the urine are far more commonly the result of conditions such as:

Urinary infection. Slight prostate inflammation (prostatitis-like symptoms). An overactive bladder. Pelvic floor tightness. Dehydration. Caffeine irritation. Sometimes a stricture of the urethra, or a small calculus. Sometimes stress and anxiety can also aggravate urinary symptoms. Your urologist has taken the right first step in ordering a urine culture. Infections are one of the most common and treatable causes. As it is not very reliable in young men and can easily cause unnecessary worry, false positives, and further testing without much benefit, a PSA (prostate-specific antigen) test is not usually recommended at your age.

Your family history means that screening is generally started later in life, often in your early 40s, depending on your doctor’s advice and local guidelines.

If you still have symptoms, even though the urine test is normal, then the next step would be to do more tests, such as flow studies, bladder scanning, ultrasound or see the urologist again. At this point, you don't want to be looking for cancer.

I hope this helps you.

Thank you.