Who’s at Higher Risk for Prostate Cancer?

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As a man ages, his risk of developing prostate cancer increases dramatically. This age-related increase is greater for prostate cancer than for any other type of cancer. The average age at diagnosis is between 65 and 70 years. Besides increasing age, several factors boost the risk of prostate cancer:

  • Family history. Having a brother or father with prostate cancer more than doubles your risk (brother more so than father). Your risk is even higher if several of your relatives have had the cancer, especially if they were young when it was found.
  • Race. Black men are 60 percent more likely to develop it than white men, and more than twice as likely to die from it.
  • Genes. Men who inherit certain genetic mutations (notably of the BRCA gene, best known for increasing the risk of breast and ovarian cancer) have elevated rates of prostate cancer. Researchers have also found that men who inherit a rare mutation on a gene known as HOXB13 are up to 20 times more likely than noncarriers to develop prostate cancer. However, the mutation is responsible for only 2 to 5 percent of prostate cancer cases.

It’s important to note that although genes can influence a man’s risk of developing prostate cancer, other factors also are at work. The likelihood that identical twins (who share all genetic information) will both develop prostate cancer is 27 percent. This suggests that lifestyle choices can modify the effects of the genetic cards that a person is dealt at birth.

Impact on screening advice

Earlier this month, the United States Preventive Services Task Force (USPSTF) issued its finalized prostate-specific antigen (PSA) screening recommendation. It states that men 55 to 69 should decide with their doctors whether to be tested, after a thorough discussion of the potential benefits and harms of PSA testing. The USPSTF does not single out any of these higher-risk groups for earlier screening, saying that more research is needed. The group discourages men 70 and older from undergoing prostate cancer screening. The American Cancer Society recommends that men at high risk-including African-Americans and those whose father or brother had prostate cancer-start discussions at age 45. Men at even higher risk-with more than one first-degree relative who had prostate cancer at an early age-should consider a PSA test at age 40. The American Urological Association (AUA) recommends that men with an increased risk of prostate cancer discuss early detection with their physicians. The AUA guideline also says that some men who are 70 and older and in excellent health may benefit from the test and should talk to their doctors about its benefits.