@brianjarvis Not that rare. When I was first diagnosed, my oncologist told me the aggressive variety accounts for about 1 in 20 cases, and given how many people have prostate cancer, that's a lot of cases.

This forum isn't a random selection (people with the more-aggressive type of prostate cancer are more likely to land here and stay longer), but we get a good number of introductory posts from people diagnosed with de-novo prostate cancer in our 50s and even 40s.

You and I agree that annual PSA screening is important — study after study has shown a steep rise in de-novo stage 4 prostate-cancer diagnoses since routine PSA screening stopped in most countries — but it's not a guarantee. As one research paper I read pointed out, sometimes the aggressive variety of prostate cancer develops so fast that you have normal PSA one year, and already have metastatic cancer by the next. In fact, that had happened to one of my hospital roommates (in his 50s): as a Canadian army vet, he had still been getting annual PSA screening, but it wasn't fast enough to catch his cancer before it metastasised. 😕