One of the first questions I ask when discussing prostate cancer risk with a patient is simple: Has anyone in your family had prostate cancer?
But the conversation should not end there.
A family history of breast, ovarian, pancreatic, colorectal, or certain other cancers may also provide important information about a man’s prostate cancer risk. As we learn more about cancer genetics, understanding your family’s complete cancer history has become an increasingly important part of prostate health.
How Much Does Family History Matter?
Most men who develop prostate cancer do not have a clearly inherited form of the disease. However, prostate cancer can run in families.
Having a father or brother who has been diagnosed with prostate cancer increases a man’s risk. That risk may be even greater when:
- Multiple close relatives have been diagnosed
- A relative developed prostate cancer at a younger age
- Prostate cancer has affected multiple generations
- A family member had advanced or aggressive prostate cancer
A strong pattern of cancer within a family may indicate that an inherited genetic change is contributing to that risk.
Prostate Cancer Is Not the Only Cancer That Matters
Patients sometimes tell me, “No one in my family had prostate cancer,” and assume they do not have a relevant family history. That is not always the case.
Some inherited genetic changes associated with prostate cancer are also found in families with histories of breast, ovarian, pancreatic, colorectal, and other cancers. This is why it is important to consider your family’s cancer history as a whole—not just its history of prostate cancer.
BRCA1 and BRCA2 are among the best-known examples of these genetic changes. Although these mutations are commonly associated with breast and ovarian cancer, they can affect men as well. BRCA2, in particular, is associated with an increased risk of prostate cancer and may be linked to a more aggressive disease.
Other inherited genetic changes may also be relevant. A urologist or genetic counselor can help determine whether the pattern of cancer in your family suggests a possible hereditary risk.
What Should You Know About Your Family?
You do not need to create an elaborate family tree before speaking with your doctor. However, it is helpful to gather as much of the following information as possible:
- Which relatives have had cancer
- What type of cancer they had
- Approximately how old they were when diagnosed
- Whether several relatives on the same side of the family had cancer
- Whether anyone developed cancer at an unusually young age
- Whether anyone has undergone genetic testing
- Whether a known inherited mutation has been identified
Remember that both your mother’s and your father’s sides of the family matter. An inherited cancer-related mutation can be passed down through either parent.
Who Should Consider Genetic Testing?
Genetic testing is not necessary for every man. It may be recommended based on a strong family history, a known inherited mutation in the family, or certain characteristics of a prostate cancer diagnosis.
For men who have already been diagnosed, genetic testing may provide information beyond why the cancer developed. In some cases, the results can help physicians make treatment decisions or determine whether a patient may benefit from certain therapies or clinical trials.
If an inherited mutation is identified, the information may also be important for relatives. Brothers, sons, daughters, and other family members may benefit from discussing their own cancer risk with a healthcare professional or genetic counselor.
Genetic counseling is an important part of this process. A genetic counselor can explain what testing may reveal, help determine which test is appropriate, and put the results into context for both the patient and his family.
Can Family History Affect When Screening Should Begin?
Yes. Prostate cancer screening should not be based on age alone.
When I discuss prostate-specific antigen, or PSA, screening with a patient, I also consider his family history, race, overall health, and other individual risk factors. Men with a strong family history or a known inherited mutation may need to begin the screening conversation earlier and may benefit from a more individualized follow-up plan.
Having an increased risk does not mean that a man will develop prostate cancer. It means that we should be more deliberate about understanding his risk and determining an appropriate screening plan.
Start the Conversation Before There Is a Problem
You should not wait for a prostate cancer diagnosis to learn about your family’s cancer history.
Ask your parents, siblings, and other relatives what they know. Write the information down and bring it to your next appointment. If someone in your family has undergone genetic testing, try to obtain a copy of the results rather than relying on memory alone.
For some men, this conversation will reveal nothing unusual. For others, it may uncover a pattern that changes how we approach screening and helps us identify prostate cancer at an earlier, more treatable stage.
If prostate, breast, ovarian, pancreatic, colorectal, or other cancers run in your family, speak with your urologist. Together, you can determine whether your family history should affect your prostate cancer screening plan and whether genetic counseling or testing may be appropriate. Schedule your appointment today.
