From the Guidelines
Prostate cancer risk factors include age, race, family history, and certain lifestyle factors, with African American men and those with a family history of prostate cancer being at higher risk, as stated in the 2019 American Cancer Society guidelines 1. Men over 50 are at higher risk, with risk increasing significantly after age 65. African American men have a higher risk than other racial groups, while men of Asian or Hispanic descent have lower rates. Having a father or brother with prostate cancer doubles your risk, and the risk increases further with multiple affected relatives or early-onset cases. Genetic mutations like BRCA1/2 and Lynch syndrome also increase risk. Lifestyle factors include obesity, which is associated with more aggressive forms of prostate cancer, and possibly diets high in red meat and high-fat dairy products, as suggested by a 2006 study on nutrition and physical activity for cancer prevention 2. Some studies suggest that inflammation from prostatitis may contribute to cancer development. While these risk factors are important to understand, many men with prostate cancer have no identifiable risk factors, and regular screening through PSA testing and digital rectal exams is recommended for men starting at age 50, or earlier for those with higher risk profiles, according to the NCCN clinical practice guidelines in oncology 3. These screenings can detect cancer early when treatment is most effective. Key risk factors to consider include:
- Age: Men over 50 are at higher risk
- Race: African American men have a higher risk
- Family history: Having a father or brother with prostate cancer doubles your risk
- Lifestyle factors: Obesity, diets high in red meat and high-fat dairy products
- Genetic mutations: BRCA1/2 and Lynch syndrome The 2018 American Cancer Society guidelines also emphasize the importance of informed decision-making for prostate cancer screening, taking into account individual risk factors and preferences 4.
From the FDA Drug Label
5. 2 Increased Risk of High-Grade Prostate Cancer Men aged 55 and over with a normal digital rectal examination and PSA ≤3.0 ng/mL at baseline taking finasteride 5 mg/day in the 7-year Prostate Cancer Prevention Trial (PCPT) had an increased risk of Gleason score 8 to 10 prostate cancer (finasteride 1.8% vs placebo 1.1%).
- 1 Increased Risk of High-Grade Prostate Cancer Patients should be informed that there was an increase in high-grade prostate cancer in men treated with 5α-reductase inhibitors indicated for BPH treatment, including finasteride tablets, compared to those treated with placebo in studies looking at the use of these drugs to prevent prostate cancer
The prostate cancer risk factors associated with finasteride use include:
- Age: Men aged 55 and over
- PSA level: PSA ≤3.0 ng/mL at baseline
- Digital rectal examination: Normal digital rectal examination at baseline
- Gleason score: Increased risk of Gleason score 8 to 10 prostate cancer
- 5α-reductase inhibitor use: Increased risk of high-grade prostate cancer in men treated with 5α-reductase inhibitors, including finasteride tablets, compared to those treated with placebo [5] [6]
From the Research
Prostate Cancer Risk Factors
- Age is a significant risk factor for prostate cancer, with the risk increasing as men get older 7, 8
- Family history and genetic predisposition also play a crucial role in determining prostate cancer risk 7, 9, 8
- Other potential risk factors include: + Smoking 7, 8 + Diet 7, 8 + Physical activity 7 + Specific medications 7 + Occupational factors 7, 8
- Finasteride has been shown to improve the sensitivity of digital rectal examination for prostate cancer detection 10
- Prostate-specific antigen (PSA) measurement is also an important tool for detecting prostate cancer, and its use in conjunction with digital rectal examination can enhance early detection 10, 11
Detection and Screening
- Digital rectal examination and PSA measurement are commonly used for prostate cancer screening 10, 11
- The sensitivity of digital rectal examination is greater for detecting higher-grade tumors 10
- PSA detection is more effective than digital rectal examination in detecting prostate cancer, especially in combination with digital rectal examination 11
- The use of magnetic resonance imaging (MRI) and biomarkers may help identify patients who are likely to harbor significant tumors and reduce the negative consequences of screening 7