What extra steps should I take if I have a family history of prostate cancer?

Risk factors for prostate (and any other cancer) can be divided into genetic and environmental. Although you can’t change the genes that you were born with, it’s important that if you have a family history of prostate cancer you understand that your risk of getting prostate cancer is 2-3x higher if you have a first-degree relative (brother or father) with this diagnosis and that the risk increases above the baseline risk of 10% of the population with each affected relative.

Whether a family history of breast cancer increases the risk of the males in that family getting prostate cancer and vice vera is still debated but in families with multiple members having breast and prostate cancer genetic testing is necessary to investigate whether the BRCA1 or BRCA2 mutations exist, which significantly increase the risk of developing breast, prostate, pancreas and ovarian cancers, amongst others https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet.

The latest research shows that men who have a high genetic risk of aggressive prostate cancer can lower their risk of death by adopting a healthy lifestyle https://www.aacr.org/about-the-aacr/newsroom/news-releases/healthy-lifestyle-may-offset-risk-of-lethal-prostate-cancer-in-men-with-high-genetic-risk/. This healthy diet consisted of maintaining a healthy weight, vigorous physical activity, not smoking, and high consumption of tomatoes, fatty fish, and reduced intake of processed meat. Adhering to this regime, participants halved their risk of death from prostate cancer from 6% to 3% during the 22-year period of the study.

Keeping fit and avoiding obesity also protects against heart and lung disease and 13 other cancers, including breast, bowel, pancreatic, oesophageal, gallbladder, endometrial, ovarian, kidney, liver, stomach, myeloma, meningioma and thyroid cancer https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/obesity-weight-and-cancer/does-obesity-cause-cancer. Having a healthy weight (a body mass index of 25 kg/m2 or less https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/) also puts less stress on your joints and spine and makes it less likely that you will need joint replacement surgery as you age.

There is currently no screening program for prostate cancer in the UK, although the largest and longest-running screening study (the European Randomised Study of Screening for Prostate Cancer (ERSPC)) showed a 53% reduction in prostate cancer deaths in men screened with PSA at 3 years intervals, compared to those who were not, at 18 years of follow-up https://pubmed.ncbi.nlm.nih.gov/29254399/. The UK’s National Screening Committee rejected the proposal for a screening program for prostate cancer for the third time in October 2020 on the grounds that over-diagnosis may lead to harms (side-effects) from over-treatment of prostate cancer, seemingly giving greater weight to this consideration than the potential harms of under-diagnosis and under-treatment, which include death.

In the absence of a screening program for prostate cancer, men who are at increased risk of getting prostate cancer i.e. those who have a family history of the condition and black men should have their PSA checked for the first time in their mid-40s and regularly thereafter. There is now evidence from more than one study that your PSA at this age predicts the future risk of developing prostate cancer https://pubmed.ncbi.nlm.nih.gov/20960520/ and https://www.bmj.com/content/346/bmj.f2023. If your PSA shows a rising trend then ask to be referred to a Urologist for further investigation. In the meanwhile, exercise regularly, watch your weight and eat a healthy diet. If you have a strong family history of prostate cancer, especially if there are also several cases of breast cancer in your family, consider asking to be referred for genetic testing as well.

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