Whos At Risk For Prostate Cancer
All men are at risk of having prostate cancer. About one man in nine will be diagnosed with it during their lifetime, but only one in 39 will die of this disease. About 80% of men who reach age 80 have cancer cells in their prostate. Besides being male, there are other things that contribute to the risk.
Criteria For Genetic Testing In Prostate Cancer
The criteria for consideration of genetic testing for prostate cancer susceptibility varies depending on the emerging guidelines and expert opinion consensus as summarized in Table 2. Identification of men for inherited prostate cancer genetic testing is based upon family history criteria, personal/disease characteristics, and tumor sequencing results. Actual genes to test vary on the basis of specific guidelines or consensus conference recommendations. The National Comprehensive Cancer Network Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic Cancer guideline is focused on BRCA1/BRCA2 testing on the basis of various testing criteria. The NCCN Prostate Cancer treatment guideline states to test BRCA1/BRCA2, ATM, CHEK2, PALB2, MLH1, MSH2, MSH6, and PMS2 for men meeting specific testing indications. A 2017 consensus conference addressed the role of genetic testing for inherited prostate cancer. Family historybased indications for testing included testing for BRCA1/BRCA2, HOXB13, or DNA mismatch repair genes. Tumor sequencing with potential findings of germline variants in BRCA1/BRCA2 or DNA MMR genes, as well as other genes, is recommended for confirmatory germline testing. Somatic findings for which germline testing is considered include:
Inherited Variants Associated With Prostate Cancer Aggressiveness
Prostate cancer is biologically and clinically heterogeneous. Many tumors are indolent and are successfully managed with observation alone. Other tumors are quite aggressive and prove deadly. Several variables are used to determine prostate cancer aggressiveness at the time of diagnosis, such as Gleason score and PSA, but these are imperfect. Additional markers are needed because sound treatment decisions depend on accurate prognostic information. Germline genetic variants are attractive markers because they are present, easily detectable, and static throughout life.
Findings to date regarding inherited risk of aggressive disease are considered preliminary. As described below, germline SNVs associated with prostate cancer aggressiveness are derived primarily from three methods of analysis: 1) annotation of common variants within candidate risk genes 2) assessment of known overall prostate cancer risk SNVs for aggressiveness and 3) GWAS for prostate cancer aggressiveness. Further work is needed to validate findings and assess these associations prospectively.
Like studies of the genetics of overall prostate cancer risk, initial studies of inherited risk of aggressive prostate cancer focused on polymorphisms in candidate genes. Next, as GWAS revealed prostate cancer risk SNVs, several research teams sought to determine whether certain overall risk SNVs were also associated with aggressiveness.
References
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Family History And Genetics
Your family history is information about any health problems that have affected your family. Families have many common factors, such as their genes, environment and lifestyle. Together, these factors can help suggest if you are more likely to get some health conditions.
Inside every cell in our body is a set of instructions called genes. These are passed down from our parents. Genes control how the body grows, works and what it looks like. If something goes wrong with one or more genes , it can sometimes cause cancer.
Is prostate cancer hereditary?
If people in your family have prostate cancer or breast cancer, it might increase your own risk of getting prostate cancer. This is because you may have inherited the same faulty genes.
My father had prostate cancer. What are my risks?
- You are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer.
- Your chance of getting prostate cancer may be even greater if your father or brother was under 60 when he was diagnosed, or if you have more than one close relative with prostate cancer.
- Your risk of getting prostate cancer may also be higher if your mother or sister has had breast cancer.
Do you have a family history of prostate cancer?
If you’re over 45 and your father or brother has had prostate cancer, you may want to talk to your GP. Our Specialist Nurses can also help you understand your hereditary risk of prostate cancer.
Risk And Other Prostate Conditions
The most common misconception is that the presence of non-cancerous conditions of the prostate will increase the risk of prostate cancer.
While these conditions can cause symptoms similar to those of prostate cancer and should be evaluated by a physician, there is no evidence to suggest that having either of the following conditions will increase a mans risk for developing prostate cancer.
Benign Prostatic Hyperplasia is a non-cancerous enlargement of the prostate. Because the Urethra runs directly through the prostate, enlargement of the prostate in BPH squeezes the urethra, making it difficult and often painful for men to urinate. Learn more about BPH.
Prostatitis, an infection in the prostate, is the most common cause of urinary tract infections in men. Most treatment strategies are designed to relieve the symptoms of prostatitis, which include fever, chills, burning during urination, or difficulty urinating. There have been links between inflammation of the prostate cancer and prostate cancer in several studies. This may be a result of being screened for cancer just by having prostate-related symptoms, and currently, this is an area of controversy. Learn more about prostatitis.
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Prostate Cancer Risk Factors
A risk factor is anything that raises your risk of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
Researchers have found several factors that might affect a mans risk of getting prostate cancer.
Who Is At Risk For Prostate Cancer
All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.
All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.
The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.
Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.
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Gene Mutations And Genetic Syndromes
It’s thought that 10% of prostate cancers are related to inherited mutations for which testing is now available. The chance that a prostate cancer is hereditary is increased if at least three relatives have had prostate cancer.
Some genetic changes associated with prostate cancer include:
- BRCA gene mutations: Both BRCA1 gene mutations and BRCA2 gene mutations carry an increased risk of prostate cancer. It’s important to note that both of these mutation types may be associated with different cancers in different family members. So, for example, your doctor may be more concerned that you have one of these mutations if you have young female relatives who have had breast cancer and another family member who has had pancreatic cancer than if you have a few male relatives who had prostate cancer at a later age.
- Lynch syndrome : This syndrome is caused by mutations in DNA mismatch repair genes and is associated more strongly with colorectal cancer.
- RNASEL mutations: These mutations affect a tumor suppressor gene.
- HOXB13 mutations: These mutations are uncommon and are associated with prostate cancer in younger men.
Gene mutations can be confusing. It is not usually the gene mutation itself that gives rise to cancer. Many of the genes associated with an increased risk of cancer are tumor suppressor genes.
Whether or not you have a family history of prostate cancer, it’s helpful to learn about hereditary cancer when looking at your risk of any type of cancer.
Established Risk Factors: Age Race And Family History
The only risk factors for prostate cancer that can be considered established are age, race/ethnicity, and family history. Study of age-specific incidence curves reveals that prostate cancer risk begins to rise sharply after age 55 years and peaks at age 7074, declining slightly thereafter. Autopsy studies confirm that prostate cancer has a long induction period, and that many men have incipient lesions in their 20s and 30s. As shows, the risk of prostate cancer is approximately 60% higher in African Americans than in whites. Mortality among African Americans is approximately double that of whites. Conflicting data exist as to whether this mortality difference is explained entirely by differences in socioeconomic status variables and stage at diagnosis, or whether an inherent difference exists between these racial/ethnic groups in the underlying biology of prostate cancer. It should be emphasized that biological explanations for these risk differences could involve genetic factors, environmental factors, or, more likely, an interaction between the two.
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Why Risk Factors Matter
One way for a man to be prepared and fully understand the possibility of prostate cancer is to be familiar with risk factors associated with it. Keep in mind having a risk factor or even several does not mean that you will automatically get prostate cancer. There can be people who have no risk factors and still develop cancer. But having the knowledge of what the risk factors for prostate cancer are can give men awareness of what they can and cant control and from there make positive changes that could reduce the incidence of developing it.
Here are 10 risk factors that might raise the possibility of a man getting prostate cancer:
Risk Factors You Cant Control
Age: The risk of developing prostate cancer increases with age. One in 10,000 men younger than 40 will be diagnosed with prostate cancer, but one in 15 men in their 60s will be diagnosed with the disease.
Family history: Being born with a gene mutation is one of the unavoidable risks of prostate cancer. Two of them include the BRCA1 and BRCA2 gene mutations. BRCA and other inherited mutations, including HOXB13 and DNA mismatch repair genes, may explain why prostate cancer runs in families. Having a father or brother with prostate cancer may double a mans risk, especially if that relative was diagnosed before age 55.
Hormones: The level of male sex hormones, called androgens, may be higher in some men than others. Higher levels of androgensmainly testosteronehave been linked to a higher risk of prostate cancer. Men who use testosterone therapy are at a higher risk of developing prostate cancer, as an increase in testosterone stimulates the growth of the prostate gland.
Prostatic intraepithelial neoplasia : This condition may be associated with increased risk of prostate cancer. PIN is a condition in which prostate gland cells look abnormal when examined with a microscope. Its not necessarily linked with any symptoms. Nearly half of men will be diagnosed with PIN before age 50.
Race: Studies show that African-American men are about 70 percent more likely to develop prostate cancer in their lifetime than Caucasian or Hispanic men.
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Family History And Genetic Factors
Inherited factors explain around 59% of prostate cancers, it is estimated. A mix of genetic/biological factors and increased diagnostic activity in affected families may underpin the familial risk. Prostate cancer risk is not associated with prostate cancer in an adoptive parent , but it is higher sooner rather than later after diagnosis in a family member, , cohort studies have shown.
Family history
Prostate cancer risk is 2.1-2.4 times higher in men whose father has/had the disease, meta-analyses have shown. Prostate cancer risk is 2.9-3.3 times higher in men whose brother has/had the disease, meta-analyses have shown. Prostate cancer risk is 1.9 times higher in men with a second-degree relative who has/had the disease, a meta-analysis has shown.
Familial prostate cancer risk is higher in men aged under 65 compared with older men, and in men with more than one affected first-degree relative or with an affected relative diagnosed aged younger than 60.
Prostate cancer risk is 19-24% higher in men whose mother has/had breast cancer, cohort studies have shown. Prostate cancer risk is not associated with breast cancer in a sister.
BRCA1 and BRCA2
Lynch syndrome
Prostate cancer risk is 2.1-4.9 times higher in men with Lynch syndrome, compared with the general population, a meta-analysis and cohort study have shown.
Whats The Main Reason Men Get Prostate Cancer
Researchers believe that a combination of factors are usually involved with the development of prostate cancer. In 10% of diagnoses, men have inherited a genetic disposition to the disease. Other things then increase their risk, including:
- Age: 65 years of age or older
- Ethnicity: Black men are at the greatest risk
- Lifestyle: Diet, physical activity, and smoking
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Inflammation Of The Prostate
Some studies have suggested that prostatitis may be linked to an increased risk of prostate cancer, but other studies have not found such a link. Inflammation is often seen in samples of prostate tissue that also contain cancer. The link between the two is not yet clear, and this is an active area of research.
Anthropometric Factors And Physical Activity
Measures of obesity and height have been extensively studied in relation to prostate cancer risk. These studies do not indicate any substantial association between either obesity or height and prostate cancer. Adult height was hypothesized to be important, in part because it is influenced by nutrition during childhood. However, attained height is not correlated with adult levels of the somatotrophin insulin-like growth factor -1, which has been linked to prostate cancer risk. The lack of association between obesity and prostate cancer is vexing because obesity reduces sex hormone-binding globulin levels, which could lead to an increase in bioavailable testosterone, and increases both insulin and bioavailable IGF-1, which are both potentially important prostate mitogens. Relatively little research has been conducted so far on body fat distribution, as opposed to total body fat. Of particular interest is abdominal fat, which has metabolic effects different from those of subcutaneous fat. In addition, investigators have hypothesized that physical activity, apart from its beneficial effect on body fat, could reduce prostate cancer risk. The data thus far, however, are not conclusive, perhaps due to difficulty in measuring physical activity in study populations or assessment of activity during the wrong period of life.
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International Rates And Migration
Prostate cancer exhibits an extraordinary amount of variation in its occurrence worldwide. For example, the incidence rate for African Americans is approximately 60-fold higher than the rate among men in Shanghai, China. Although part of this disparity is due to differences in diagnostic ascertainment and the prevalence of screening, mortality rates, which are less subject to such influences, also vary profoundly. For example, the mortality rate for African Americans from 1988 to 1992 was approximately 12 times higher than the mortality rate in Hong Kong. These differences notwithstanding, mortality is increasing faster in the westernizing parts of Asia than anywhere else in the world. Observation of Asian migrants, moreover, provides the most compelling argument for environmental influences linked to Western lifestyle as causal factors in prostate cancer. Japanese Americans have an incidence rate 43 times higher than their counterparts in Japan, and there are data indicating that migrants develop the high-risk pattern within one generation., Shimizu and colleagues reported that prostate cancer incidence rates in Los Angeles among migrants from Japan were similar regardless of whether men immigrated early or later in life. We interpret this to mean that environmental forces can accelerate the progression of latent tumors even late in life.
Rectal Exams And Blood Test
Prostate specific antigen, or PSA, is a blood test that looks for a protein made by the prostate and prostate cancer cells. When this test is used to screen healthy men between the ages of 5569 years old, it can decrease prostate cancer death by about 20%. Your doctor will draw blood and pair it with a digital rectal exam for initial screening.
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Risk Factors In Aggressive Vs Slow
In the past few years, weve learned that prostate cancer really is several diseases with different causes. More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.
For example, while smoking has not been thought to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer. Likewise, lack of vegetables in the diet is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.
Body mass index, a measure of obesity, is not linked to being diagnosed with prostate cancer overall. In fact, obese men may have a relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume. However, obese men are more likely to have aggressive disease.
Other risk factors for aggressive prostate cancer include:
- Tall height
- Lack of exercise and a sedentary lifestyle
- High calcium intake
- Agent Orange exposure
Research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease. You can learn more about how dietary and lifestyle changes can affect the risk of prostate cancer development and progression in PCFs Health and Wellness: Living with Prostate Cancer guide.