From the Guidelines
The main risk factors for prostate cancer include age, family history, and race, with Black men having a higher risk and more aggressive forms of the disease, as supported by the most recent evidence from 1.
Key Risk Factors
- Age: Risk increases significantly after age 50, with more than 70% of all patients with prostate cancer being older than 65 years at the time of diagnosis, as noted in 1.
- Family History: A family history of prostate cancer, particularly if a father or brother had prostate cancer, increases the risk, with the risk increasing with the number of relatives affected, as discussed in 1.
- Race: Black men have a higher risk and more aggressive forms of the disease compared to other racial groups, with age-adjusted incidence rates being 75% higher than those among non-Hispanic white men, as reported in 1.
Additional Factors
- Genetic factors, such as mutations in genes like BRCA1, BRCA2, and HOXB13, contribute to the risk of prostate cancer, as mentioned in 1.
- Diet and lifestyle factors, including a diet high in red meat and fat, obesity, and exposure to certain chemicals like Agent Orange, may also increase the risk, as suggested by various studies, including 1.
Screening Recommendations
- Men should consider regular screening starting at age 45, or earlier if they have risk factors, and discuss their family history with healthcare providers to determine appropriate screening schedules, as recommended in 1.
- Maintaining a healthy weight, eating a balanced diet rich in fruits and vegetables, and exercising regularly may also help reduce the risk of developing aggressive prostate cancer, as implied by the available evidence.
From the Research
Risk Factors for Prostate Cancer
- Family history of prostate cancer is a significant risk factor, with men having a first- or second-degree relative with metastatic prostate cancer being at increased risk 2, 3, 4, 5
- Germline mutations in DNA repair genes such as BRCA2, BRCA1, ATM, CHEK2, and MSH2/MSH6 may also increase the risk of developing aggressive prostate cancer 2, 4, 5
- Polygenic risk score (PRS) in the top 20% is associated with increased odds of early lethal disease 5
- Rare variants in DNA repair genes are associated with increased odds of early lethal disease 5
- Lifestyle factors may also play a role in the risk of early lethal prostate cancer, with healthy men having lower odds of early lethal disease compared to unhealthy men with any genetic factor 5
Screening and Management
- Men with a family history of prostate cancer or germline mutations in DNA repair genes may benefit from earlier screening, such as baseline prostate-specific antigen and digital rectal exam at age 40 or 5 years earlier than the age of diagnosis of the youngest first- or second-degree relative with metastatic prostate cancer 2
- Yearly digital rectal examination and prostate-specific antigen testing may decrease prostate cancer death in men with a positive family history 3
- Active surveillance may be a suitable treatment option for men with low-grade prostate cancer, regardless of family history 6