From the Guidelines
Men with a family history of prostate cancer, specifically a first-degree relative diagnosed before age 65, should begin screening at age 45, as this is considered a significant risk factor that warrants earlier screening. This recommendation is based on the most recent and highest quality study, which suggests that men with affected first-degree relatives have approximately twice the risk of developing prostate cancer compared to those without such family history 1. The genetic influence appears stronger when relatives are diagnosed at younger ages, which is why the age of diagnosis under 65 is particularly significant.
Key Points to Consider
- Men at average risk should begin prostate cancer screening at age 50, but those with a family history of the disease should start earlier, at age 45, or even 40 if multiple first-degree relatives were diagnosed before age 65.
- The screening process typically involves a prostate-specific antigen (PSA) blood test and possibly a digital rectal examination (DRE).
- Patient decision aids are helpful in preparing men to make a decision about whether to be tested, and asymptomatic men with less than a 10-year life expectancy should not be offered prostate cancer screening.
- For men who choose to be screened, the screening interval can be extended to every 2 years if the PSA level is less than 2.5 ng/mL, and a PSA level of 4.0 ng/mL or higher is generally used to recommend referral for further evaluation or biopsy.
Importance of Individualized Risk Assessment
It is crucial for men to discuss their family history with their healthcare provider to determine the most appropriate screening schedule based on their individual risk profile. This approach allows for personalized decision-making, taking into account the benefits, risks, and uncertainties associated with prostate cancer screening and therapy, as emphasized in the American Cancer Society guidelines 1.
From the Research
Family History and Prostate Cancer Risk
- A family history of prostate cancer is considered a significant risk factor for the disease 2, 3, 4, 5
- Men with a positive family history of prostate cancer are at increased risk of developing the disease, particularly if they have multiple affected first-degree relatives 2, 4
Age and Family History
- The risk of prostate cancer associated with a positive family history increases with decreasing age at diagnosis of the relative 5
- Men with a family history of prostate cancer are diagnosed and die at earlier ages than men without a family history of prostate cancer 5
- First-degree relatives in high-risk families should begin screening before age 50 years 2
Screening Recommendations
- There is no consensus on the exact age at which a family history of prostate cancer becomes a significant risk factor warranting earlier screening 6, 2, 3, 4, 5
- However, studies suggest that men with a family history of prostate cancer should consider earlier screening, potentially before age 50 years 2