B-076 Prostate Cancer in Men Under 50: The Impact of Race/Ethnicity and Family History

Abstract

Prostate cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines offer varying recommendations on prostate cancer screening, and most are focused on men aged 50–69. In this study, we examined the impact of key risk factors, particularly race/ethnicity and family history, on prostate cancer in men under 50. This retrospective analysis utilized data from our hospital's prostate cancer screening program collected between 2014 and 2024. In our cohort, men under 50?years of age underwent prostate biopsy after screening triggered by PSA =4 ng/mL or other clinical suspicion, a total of 312 men were included. PSA was measured by electrochemiluminescence immunoassay, and all biopsies were transrectal ultrasound guided. We assessed the association of Gleason scores (benign, 6, =7), race/ethnicity, family history, and PSA levels using descriptive statistics analyses. Among 312 participants, the largest subgroup was White or Caucasian (n=202, 64.7%), followed by Black or African American (n=47, 15.1%), Hispanic or Latino (n=46, 14.7%), and Asian or Pacific Islander (n=17, 5.5%). Black or African American men had a higher proportion of Gleason 7 and above (61.7%) than any other groups. Gleason scores also differed by race/ethnicity (p=0.013). A first-degree family history (father or brother with prostate cancer) was most common in Black or African American men (51.1%) and was associated with higher Gleason scores across multiple groups (p=0.016). PSA levels increased with disease severity: benign 5.1 ng/mL, Gleason 6 = 18.7 ng/mL, and Gleason =7 = 64.9 ng/mL. Men with a first-degree family history had the highest average PSA overall (72.9 ng/mL) and very high values in the group with PSA >10 ng/mL (mean 249.4 ng/mL). By race, Black or African American men also had the highest average PSA (86.9 ng/mL). In men under 50, race/ethnicity and a positive first-degree family history identify subgroups with higher-grade cancer and higher PSA at diagnosis. These data support risk-adapted screening and early detection in younger, high-risk men. Our findings align with contemporary evidence and support the development of more risk-based personalized screening policies.