Clinicopathological Characteristics of Early-Onset Prostate Cancer in Black African Men: A Single-Centre Cohort from Johannesburg

Purpose Early-onset prostate cancer (EOPC) is poorly characterised in African populations. We describe the clinicopathological features of men aged ≤ 55 years diagnosed with prostate cancer at a Johannesburg public-sector hospital. Methods We retrospectively analysed men aged ≤ 55 years with histologically confirmed prostate adenocarcinoma enrolled at the Chris Hani Baragwanath Academic Hospital site of the Men of African Descent and Carcinoma of the Prostate (MADCaP) Consortium between October 2016 and August 2020. High-risk or advanced disease and clinically significant disease were study-defined composites adapted from EAU risk groups. Exploratory logistic regression assessed associated factors. Results Seventy-seven of 1,095 men (7.0%) were aged ≤ 55 years; median age was 53 years. High-risk or advanced disease was present in 38 men (49.4%) and clinically significant disease in 56 (72.7%). Initial PSA exceeded 20 ng/mL in 35 men (45.5%), 23 (29.9%) had ISUP Grade Group 4–5 disease, and distant metastases were documented in 8 of the 69 men with an assessable M stage (11.6%). Median initial PSA was 17.8 ng/mL. Prior prostatitis or inflammation was recorded in 63 men (81.8%), and 53 (68.8%) had been treated for urinary symptoms before the cancer diagnosis. Abnormal digital rectal examination was associated with both study endpoints after adjustment, although confidence intervals were wide. Conclusion Early-onset disease accounted for 7.0% of prostate cancers at this centre; half met criteria for high-risk or advanced disease and almost three-quarters for clinically significant disease. The frequency of prior prostatitis diagnoses and urinary treatment highlights the need to better understand diagnostic pathways in younger men.