Cancer genetics - prostate cancer
Sometimes, men worry about getting prostate cancer because a relative has had it.
More than 1 in 3 people in the UK will get cancer during their lives. Everyone has a certain risk of developing cancer. It’s thought that this is affected by a combination of our genes, lifestyle and environment.
Most of the time, we don’t know exactly what causes any particular cancer. But we do know some of the risk factors for cancer. Risk factors are things that can make you more likely to develop cancer. They include things such as being older and smoking.
Some risk factors are very likely to cause cancer. Others only slightly increase the risk of getting it. Usually, cancer is the result of a combination of several risk factors.
Having a particular risk factor doesn’t mean that you’ll definitely get cancer - just as not having any risk factors doesn’t mean you won’t.
Smoking is a good example of this. If you smoke, it isn’t certain that you will get lung cancer - just as if you don’t smoke, it’s not certain that you won’t. But smoking will greatly increase your risk of getting lung cancer. About 9 out of 10 people who develop lung cancer are smokers.
For most people, increasing age is the biggest risk factor for developing cancer. In general, older people (those over 65) are far more likely to develop cancer than younger people (those under 50).
Cancer is very common. Most of us have relatives who’ve had cancer. People often worry that a history of cancer in their family greatly increases their risk of developing it. But in fact, fewer than 1 in 10 cancers (5-10%) are associated with a strong family history of cancer.
How does family history affect prostate cancer risk?
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Most prostate cancers aren’t caused by inherited cancer genes and most men who get prostate cancer don’t have a family history of it.
If you have just one relative who developed prostate cancer at an older age, your risk is unlikely to be very different from other men the same age as you. But sometimes prostate cancer can run in families.
In general, the more men in a family who have been diagnosed with prostate cancer, the younger they were when diagnosed, and the more closely related they are, the more likely it is there’s a family link.
Examples of a family history that may mean you are at increased risk of developing prostate cancer include having:
One first-degree relative who developed prostate cancer at or under the age of 60. A first-degree relative is a father, brother or son.
Two or more close relatives on the same side of the family who developed prostate cancer. A close relative is a father, brother, son, grandfather, uncle or nephew.
Experts think that 5-15% of prostate cancers are linked to inherited gene changes that increase the risk of developing it.
There isn’t one specific ‘prostate cancer gene’ that explains most of the cases of hereditary prostate cancer. Instead, it’s thought that variations in several genes may be involved. Each variation only has a very small effect on a man’s risk. But men who have inherited several of these genetic variations may have a significantly increased risk of prostate cancer.
Scientists are trying to develop a test that could identify men who are at higher risk. But a test isn’t available in the UK yet.
In a small number of men, prostate cancer is linked to the breast and ovarian cancer genes BRCA1 and, particularly, BRCA2. So, if you have a relative with prostate cancer and there is also a strong history of breast or ovarian cancer in the same side of the family, this may be due to a BRCA1 or BRCA2 gene.
However, most families with a strong history of prostate cancer don’t have the BRCA1 or BRCA2 genes.
If a close relative has been diagnosed at a younger age, or more than one close relative has had prostate cancer, you may want to discuss this with your GP. They may be able to reassure you or refer you to a clinical genetics service or a family cancer clinic if needed.
Your doctor can also discuss with you the benefits and disadvantages of having screening tests to check for prostate cancer. Screening may include the PSA test, which is a blood test to check the level of a protein called prostate-specific antigen (PSA) in your blood. It may also involve a digital rectal examination (DRE), which is when the doctor gently inserts a gloved finger into your back passage to check for any abnormalities in the feel of the prostate gland.
We have more information about the PSA test including a video outlining the advantages and disadvantages as well as more information on screening below.
Most men who develop prostate cancer don’t have a strong family history of it. Other risk factors can play a more important role in the development of prostate cancer.
The strongest risk factor for prostate cancer is increasing age. More than 9 out of 10 men (90%) who are diagnosed with prostate cancer are over 65. Prostate cancer is rare in men under 50.
Men from certain ethnic groups have a higher chance of developing prostate cancer. Black men from an African-Caribbean or African background are three times more likely to develop prostate cancer than white men. Asian men are the least likely to develop prostate cancer.
Being overweight doesn’t increase the risk of developing prostate cancer. But men who are overweight may be more likely to develop more aggressive types of prostate cancer or be diagnosed with advanced prostate cancer.
Some evidence suggests that diet can affect your risk of developing prostate cancer, but this is not completely clear. Current thinking suggests that a diet high in animal fats may increase your risk of developing prostate cancer. In particular, red meat (such as beef, lamb and pork) and dairy produce (including butter, full-fat milk, cheese, eggs and cream) contain a lot of saturated fat.
There is some research that suggests that smoking can increase the risk of prostate cancer.
Some cancer risk factors, such as age and family history, are beyond our control. But there are some we can control, known as lifestyle risk factors. These include things like diet, weight, exercise and smoking.
The evidence for whether lifestyle factors can affect a man’s risk of prostate cancer, and by how much, isn’t clear.
We know that rates of prostate cancer are lowest in men in countries such as China and Japan. But when men from these countries move to Western countries, their risk of prostate cancer increases. This seems to suggest that lifestyle factors such as diet do play a part in prostate cancer risk. Japanese and Chinese diets contain more fruit, vegetables and fish, and less meat, fat and processed foods than the Western diet.
Here are some things you may want to consider to reduce your cancer risk generally:
Eat a healthy diet
To reduce your cancer risk, eat foods high in fibre, such as beans and oatmeal, and eat at least five portions of fruit and vegetables a day. Limit your intake of red meat and salt, and avoid processed meats. Processed meats are meats that have had preservatives added or that have been preserved by salting, curing or smoking. They include sausages, ham and burgers.
Eating a healthy diet can also lower your risk of developing other illnesses such as heart disease and diabetes.
Keep to a healthy weight
The latest figures for the UK estimate that about two thirds (66%) of men are overweight.
If you are overweight, getting back to a healthy weight will help reduce your risk of cancer. Being overweight increases the risk of several types of cancer, including cancers of the pancreas, bowel and kidney.
Leading an active lifestyle and eating a healthy diet can help. Your GP can give you more advice about managing your weight.
Give up smoking
There is some evidence to suggest that smoking may increase your risk of developing prostate cancer. And we know that it increases the risk of many other cancers including cancers of the mouth, throat, lung, bladder, kidney, pancreas, bowel and stomach.
Smoking is the single biggest avoidable cause of cancer.
Smoking also increases your risk of heart disease and high blood pressure. If you smoke, giving up is the single most important thing you can do for your health.
Help is available if you want to give up smoking. Ask your GP for advice, or contact your national stop smoking service.
Tel 0800 022 4332
(Mon-Fri, 9am-8pm, Sat-Sun, 11am-4pm)
Tel 0800 84 84 84
Stop Smoking Wales (Wales)
Tel 0800 085 2219
Smokers’ Helpline (Northern Ireland)
Tel 0808 812 8008
Keep physically active
It’s not clear whether being more physically active can help to reduce your risk of prostate cancer. Different studies have given different results, with some finding a reduction in risk and others not.
Being physically active is good for your general health and it will reduce your risk of cancer, especially bowel cancer.
Being physically active doesn’t necessarily mean going to the gym - regular walking, cycling or swimming can be enough.
Try to do at least 2½ hours of moderate intensity physical activity a week. This could be made up of 30 minutes of activity on five days of the week. You could break it up further into 10 minutes of activity, three times a day.
During moderate-intensity exercise, you’re still able to talk, but your breathing is quicker and deeper. Your body is warming up, your face may have a healthy glow and your heart is beating faster than normal but not racing.
If you’re not used to exercise, your GP can advise you on getting started.
Limit how much alcohol you drink
There’s no evidence of a link between alcohol and prostate cancer, but following guidelines on healthy limits can help reduce your risk of developing other cancers.
The European Code Against Cancer recommends that to reduce cancer risk, men should drink no more than two units of alcohol a day. A unit is half a pint of ordinary strength beer, lager or cider, one small glass (125ml) of wine or a single measure (25ml) of spirits.
Making the lifestyle changes described here doesn’t mean that you definitely won’t get cancer, but they make it less likely and will improve your health generally.
Most prostate problems are not caused by cancer, but if you have any of the following symptoms, it’s important to have them checked out by your GP:
a poor flow of urine, perhaps stopping and starting
difficulty in starting to pass urine
passing urine more often than usual, especially at night
feeling an urgent need to pass urine
feeling you’ve not fully emptied your bladder after passing urine
pain when passing urine.
These symptoms are usually caused by non-cancerous changes in the prostate rather than by cancer. But if you experience any of them, it’s always important to get them checked out.
You can find more information about prostate problems from Prostate Cancer UK.
Regular checks for prostate cancer
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There isn’t an organised screening programme for prostate cancer in the UK. But a blood test called the PSA test is often used to check for problems in the prostate. It measures the level of a specific protein, which can be raised by various prostate problems.
The PSA test isn’t a straightforward test for prostate cancer. A raised PSA level is a sign of a change in the prostate, but it can’t tell you for certain whether you have prostate cancer. About 2 out of 3 men who have raised PSA levels don’t have prostate cancer. And up to 1 in 6 men with prostate cancer have a normal PSA result.
Not all prostate cancers need treatment, so it may not always be to your advantage to know if you have cancer in your prostate. Prostate cancers vary from slow-growing tumours to very aggressive tumours. Slow-growing tumours are common and may not cause any symptoms or shorten life. Many men with slow-growing tumours will die with their cancer, rather than because of it.
To help you weigh up these issues and decide whether having the PSA test is right for you, the NHS has organised an informed choice programme called the Prostate Cancer Risk Management programme.
If you’re worried about your risk of prostate cancer, talk to your GP. They can help you make an informed decision about the benefits and disadvantages of the PSA test. There’s also an online decision aid called Prosdex. This provides information and real-life experiences to help you decide what feels right for you.
If you are still worried
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A common reaction to serious illness in the family, or to bereavement, is to feel more vulnerable to the same disease. If you can’t stop worrying, you may find it helpful to speak to a counsellor. You can ask your GP for details of a local counselling service, or contact our cancer support specialists.
The mental health charity MIND has a leaflet called How to Stop Worrying. Order a copy from their website or by calling 0300 123 3393.