The male prostate is a walnut-sized gland located in the lower abdomen just below the urinary bladder.
It is the main source of fluid in semen, and powerful muscles allow it to expel sperm cells on orgasm and ejaculation. The prostate produces most of the liquid a man discharges on ejaculation.
Unfortunately, as a man ages, the prostate gland’s usually seamless function often becomes more troublesome.
The two main problems associated with the gland are Benign Prostate Hyperplasia (aka BPH or prostate enlargement) and prostate cancer. 1
Prostate enlargement is quite common in older males and almost always causes urinary as well as sexual problems. Prostate cancer also begins in the male prostate gland. Other than skin cancer, it is the most common cancer found in men. Both issues are very treatable, albeit in vastly different ways.
BPH is not usually a life-threatening condition, but prostate cancer can be. According to the American Cancer Society, the 5-year survival rate for prostate cancer is close to 100 percent.
Ten and fifteen-year survival rates are also well over 90 percent. Prostate cancer is very treatable, especially for those whose cancer has not spread beyond the prostate. In the case of metastatic prostate cancer (spread outside of the prostate), survival rates diminish.
Inheriting Prostate Cancer
Most prostate cancer occurs in men without a family history of it, but according to most expert sources, having a first-line relative (father or brother) that has been diagnosed with prostate cancer more than doubles the risk of developing it. This suggests that there may be an inherited or genetic factor in some cases.
A small percentage of all prostate cancers cluster in families. These hereditary cancers seem to be associated with inherited gene mutations, and such cancers tend to develop earlier in life. The risk is higher for men with several affected relatives, especially if they are diagnosed when younger than 50.
Other Risk Factors for Prostate Cancer
To date, there is no known, specific cause of prostate cancer, but the risk of developing the disease is definitely linked to age.
As mentioned above, most prostate cancer occurs in men without a family history of it. A family history of first-line relatives with the disease does convey a small but increased risk.
Aside from genetic changes, researchers have identified many environmental, lifestyle, and dietary issues that may contribute to the risk of developing prostate cancer.
These factors include:
- A high animal fat diet that includes red meat and dairy products.
- Insufficient intake of natural food items like fruits and vegetables,
- Obesity and an inactive (sedentary) lifestyle
- Excessive alcohol use
- Exposure to toxic chemicals. 2
- Race – African American men have a 70 percent greater lifetime risk than Caucasian or Hispanic men.
- A first-line relative (father or brother) diagnosed with prostate cancer
- Ejaculation Frequency – Men with less than 4-7 ejaculations per month had nearly a 20 percent higher risk for prostate cancer. 3
Understanding the Risk for Hereditary Prostate Cancer
Inherited gene mutations are present in approximately 5 to 10 percent of all men diagnosed with prostate cancer. The higher percentage seems to be associated with the metastasized disease.
A history of prostate cancer is closely related to family members is certainly a risk factor. Still, it is essential to remember that, while a gene mutation may increase the risk of developing the disease, it is not an indicator that a specific person will develop prostate cancer.
Genetic mutations in genes, such as BRCA1, BRCA2, and HOXB13, add a small amount of risk to a moderate lifetime risk of prostate cancer. The BRCA2 mutation gene has been shown to have clinical relevance in both the etiology and the treatment and prostate cancer screening.
The BRCA1 and BRCA2 genes are involved in repairing damaged DNA. Mutations in these genes may impair the cell’s ability to fix damaged DNA. Such defects can accumulate, possibly causing cells to grow uncontrollably into a tumor.
Men with mutations in these genes have a higher risk of developing prostate cancer as well as other cancers during their lifetimes. Some mutations can contribute to an increased risk of developing a severe and life-threatening form of prostate cancer.
However, it seems that mutations in these genes may increase the aggressiveness of cancer; they are only small contributors to overall prostate cancer risk. 4
Like breast cancer in women, the combined influence of specific gene mutations and variations can increase prostate disease risk. However, gene mutations are not specific indicators that someone will develop the disease.
One of the most significant risks facing a worried man is that he will overestimate his risk and coerce a doctor to run unnecessary tests to establish disease. While the tests may be of no consequence, the treatment arising from such testing may cause debilitating side effects. Keep in mind that most prostate cancer develops in men that have no family history of it.
There are hundreds of tests available in the National Institute of Health (NIH) genetic testing registry, including 519 tests in the prostate cancer database. Testing can be expensive, and a man with a family history of prostate cancer may easily spend a small fortune on gene or another testing with little to no actual results. 5
Another issue a man should consider, especially if he has a first-line relative with prostate cancer, is the age at which a relative’s ′ cancer was detected. Cancer detected in a young man is often more severe than a similar detection in an older man.
Prostate cancer is a disease that presents in many different flavors. From an early-detected aggressive disease with a high likelihood of metastasizing and becoming life-threatening to a small localized prostate tumor (localized prostate cancer) in an older man that may contain cancerous cells yet never cause any symptoms or become a threat to his well-being and could be monitored through active surveillance.
A test may show a mutated gene related to cancer development, but such tests are also non-definitive. Cancer may never form in someone with prostate cancer genes, and more than 90 percent of cancers have been known to develop in men without any notable gene mutations.
Genetic Counseling For Prostate Cancer
Identifying genetic risk factors for prostate cancer is a significant and on-going area of medical research.
Recent studies suggest a higher prevalence of inherited cancer risk genes in men with advanced prostate cancer. Thus, while a gene mutation may not have caused cancer, its aggressiveness may have been influenced more than previously thought.
Only about 5 to 10 percent of all prostate cancer diagnosed is hereditary. This may be due to a mutation in one of the known genes associated with the condition, or it might simply mean that an increased risk for the disease runs in the family for unknown reasons. (See Conclusion below)
Genetic consoling applies to men with specific inherited changes (mutations) in genes associated with a higher risk of cancer. It is the job of a genetic counselor to explain both benefits and risks to the patient and stress that state of the art has limitations.
A positive result from a genetic test is not a death sentence. It does not specifically indicate the patient will develop cancer. However, a patient’s ′ psychological status can weigh heavily on both his mind and the minds of his loved ones.
In our fast-paced society, people often assign more weight to medical testing than deserved. A positive result does not indicate an impending cancer diagnosis. Likewise, an adverse effect is not a guarantee that the patient will not develop cancer.
Genetic testing and consoling are not for everyone. Testing can indicate a potential issue, but it is only through a genetic adviser’s wisdom and experience that the advantages and risks of genetic testing and consoling can be examined. Any man considering treatment based on the outcome of genetic testing should be sure to weigh the many pros and cons.
In recent years, studies have begun to identify several heritable genetic changes that may contribute to a person’s risk of developing prostate cancer. However, this is a new and exciting field of research. Investigators are working to determine to what extent genetic mutation plays in the etiology of the disease.
Prostate cancer is a hereditary cancer, albeit only a small percentage of cases seem to be directly inherited. Understanding more exactly the role of an inherited mutation may lead to improved methods to identify men at increased risk of aggressive disease.
New drugs and therapies explicitly aimed at mutated genes are becoming increasingly available in clinical trials, and some of them may yet prove effective. 6
Prostate cancer clinicians are largely unfamiliar with cancer genetics, and the genetics community has limited familiarity with prostate cancer. Add to this, the shortage of genetic counselors, challenges with insurance coverage for genetic testing, various misconceptions, and the implementation of a plausible treatment plan becomes murky.
Prostate Cancer Screening
Prostate cancer screening is typically in the form of a prostate-specific antigen (PSA) test and a digital rectal exam. Such screening is not recommended for men ages 76 or older.
A high PSA level does not generally mean that a man should have a prostate biopsy. A PSA test is often repeated after a few months to determine if the PSA level is still high and further investigate.
Limited information is available about the efficacy of screening tests in men genetically predisposed to developing prostate cancer.
Men with known genetic mutations in certain genes should engage in shared decision-making with their health care providers and develop individualized plans for prostate cancer screening based on their risk factors. Examination of the inherited variants may greatly influence treatment options.
There is a balance between the harms and benefits of screening. By focusing screening on men at the highest risk for life-threatening prostate cancer, we can better achieve this balance. 7
The risks of acquiring prostate cancer are mostly the same as for any cancer. A poor diet and lack of exercise top the list. But is prostate cancer hereditary? Specifically, having a close male relative already diagnosed with prostate cancer does add to the usual risk factors.
An inherited risk due to gene mutation only accounts for about 5 to 10 percent of prostate cancer cases. Most cases of prostate cancer occur in men with little to no family history of the condition. But, consideration must be given to the fact that many men follow the path of the fathers, especially regarding culture, diet, and lifestyle issues.
This correlation often extends to familial conditions, such as prostate or heart problems, as well as overall health conditions.
Medical science tries to attribute this to measurable factors, such as gene mutations. However, cultural factors, such as diet and lifestyle that are often duplicated generation to generation, result in similar risks, father to son, as well as to siblings, with or without gene mutations. Thus, shared factors such as environment and lifestyle may also confer additional risk. Practitioners often ignore this risk by seeking to find a measurable gene mutation or similar malfunction that may or may not exist.
In my career, I have noted many patients who simply refuse to believe their diet and lifestyle are increasing their risk for life-threatening conditions such as; prostate cancer, stroke, and heart attacks.
According to the latest studies, most prostate cancer does not present a threat to life. It is often difficult for medical professionals to separate cancers that may be life-threatening from indolent ones, but improvements in diagnosis are being continuously made.
Prostate cancer is both over-diagnosed and over-treated in most areas of the Western world today. Any aging man faces the likelihood of a prostate cancer diagnosis every time he visits his doctor for an annual exam.
While it is the man′s doctor who usually makes the diagnosis and recommended treatment approach, the patient must take overall responsibility for the outcome, both physically and emotionally.
A diagnosis of prostate cancer is devastating for both a man and his partner. However, one comforting factor is that most prostate cancer is not deadly, and the life expectancy after a diagnosis, regardless of the extent of treatment, is relatively high.