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Prostate cancer: What's family got to do with it?

Learn how family history may affect your risk for prostate cancer—and what you can do about it.

A man's father and grandfathers can have a profound effect on his life, from the way he looks to his hobbies and interests. They can also influence his risk for health problems like prostate cancer—the second most common cancer in men after skin cancer.

If you have a father, grandfather or brother who has had prostate cancer, it's a good idea to take some time to learn more about your risk for the disease.

Family history and risk

Prostate cancer is caused by changes in the DNA of prostate cells, according to the American Cancer Society (ACS). Since we inherit DNA from our parents, family history is an important risk factor for prostate cancer.

"Having a first-degree relative, such as a father or brother, with the disease pushes your risk above average," says Durado Brooks, MD, vice president of cancer control interventions, prevention and early detection at the ACS. "If prostate cancer runs through multiple generations of your family—such as in a grandfather and father—your risk is higher than if only a single generation is involved."

But, he adds, "Once we go beyond that, the evidence for increased risk gets a little blurry."

For example, having an uncle with prostate cancer confers some risk to you, Dr. Brooks says. But whether it's a significant risk or not, we don't know.

We do know, however, that how old a close relative was when he was diagnosed with prostate cancer plays a significant role. Because the disease is much more common in older years, its occurrence late in life is more likely caused by age than genetics.

"If your father was diagnosed with prostate cancer in his 80s, there's a question as to whether you have any significantly increased risk at all," Dr. Brooks says.

Other risk factors

Of course, family history isn't the only thing that can make you more vulnerable to prostate cancer. Other influences include getting older (the strongest risk factor) and being African American. Lifestyle factors may also be involved, but their effects are not clear.

Prevention and screening

If you are concerned about your risk for prostate cancer, consider:

Talking with your doctor about screening. Two methods used to screen for prostate cancer are a digital rectal exam and a blood test that measures levels of prostate-specific antigen (PSA). Neither method can tell if you have cancer; they can only suggest a need for further testing.

The PSA test is, in Dr. Brooks' words, "relatively inexact." The higher your PSA level, the more likely you have a prostate problem. But the problem could be age-related enlargement of the prostate or a mild infection, not cancer.

In addition, some prostate cancers grow at a snail's pace. A high PSA reading might lead to diagnosis and treatment that not only is unnecessary, but also causes side effects, such as impotence or incontinence.

Men who are African American or whose family history of prostate cancer includes one first-degree relative should talk with their doctors about the potential benefits and risks of screening starting at age 45, according to the ACS.

Men who have more than one first-degree relative who had prostate cancer at an early age should talk to their doctors about screening starting at age 40.

Men who are at average risk of prostate cancer and are expected to live at least 10 more years should talk with their doctors about the pros and cons of screening at age 50.

Taking preventive medications. Two medications for benign prostate enlargement—finasteride and dutasteride—may also prevent cancer in some men, Dr. Brooks says. However, two studies found that when prostate cancer did occur in men taking the drugs, it was an aggressive form of the disease.

"So there is a question as to the balance of benefits and risks of these medications," he says.

Living a healthy life. Although the exact role of diet and exercise on prostate cancer risk is unclear, "lifestyle changes have the potential to be beneficial in reducing prostate cancer risk," says Dr. Brooks. And they are beneficial in reducing the risks of some other cancers, heart disease and diabetes.

Tips from the American Institute for Cancer Research, the ACS and others include:

  • Choose a nutritious diet that emphasizes a variety of fruits, vegetables and whole grains and legumes.
  • Limit your intake of high-fat dairy.
  • Limit red meat consumption and avoid processed meats.
  • Maintain a healthy weight.
  • Get at least 30 minutes of exercise every day.
  • Avoid alcohol and tobacco.

Studies on the benefits of vitamins and supplements on prostate cancer prevention have been inconsistent, according to the ACS. The group suggests talking to your doctor before adding any to your daily routine.

reviewed 2/12/2020

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