Prostate cancer risk factors: age, family history and what helps

What prostate cancer is

The prostate is a gland in the male reproductive system, about the size of a walnut, just below the bladder. It makes fluid that is part of semen (NCI PDQ) (MedlinePlus). Prostate cancer is the second most common cancer among men in the United States. About one out of every eight men will be diagnosed with it, and most men diagnosed with prostate cancer do not die of it (NCI PDQ). It often grows very slowly, but sometimes it grows quickly and spreads, and that kind is serious (MedlinePlus).

Risk factors that raise the risk

The National Cancer Institute (NCI) and MedlinePlus list these (NCI PDQ) (MedlinePlus):

• Age. Prostate cancer is rare in men younger than 50. The chance of getting it goes up with age (NCI PDQ).
• Family history. A man whose father, brother or son has had prostate cancer has a higher than average risk (NCI PDQ).
• Race. Prostate cancer is more common in African American men than in White men. African American men are also more likely to get it at a younger age, to have more serious prostate cancer and to die from it (NCI PDQ) (MedlinePlus).
• Inherited gene changes. Prostate cancer happens when there are changes in the DNA. Sometimes these changes are inherited, meaning you are born with them; other changes happen during your lifetime. Often the exact cause is unknown (MedlinePlus).
• Hormones. Testosterone is changed in the body into dihydrotestosterone (DHT). DHT is needed for normal prostate growth but may also play a part in prostate cancer (NCI PDQ).
• Vitamin E pills. In the SELECT trial, vitamin E taken alone raised the risk, and the risk stayed higher even after the men stopped taking it (NCI PDQ).
• Folic acid pills. In a 10-year study, men who took 1 milligram (mg) folic acid supplements had a higher risk. Men who got enough folate from their diet had a lower risk (NCI PDQ).
• Dairy and calcium. A diet high in dairy foods and calcium may cause a small increase in risk (NCI PDQ).

Which ones you can change

What may lower the risk

• Folate from food. Folate is a B vitamin in foods such as green vegetables, beans and orange juice. Men who had enough folate in their diets had a lower risk (NCI PDQ).
• Finasteride and dutasteride. These drugs block the change of testosterone into DHT. They have been shown to lower the risk of prostate cancer, but it is not known if they lower the risk of dying from it. In the trials, men taking them had more side effects, such as erectile dysfunction, less desire for sex and enlarged breasts (NCI PDQ). This is a question for your provider.
• Healthy habits. MedlinePlus says being at a healthy weight, quitting smoking, getting enough exercise and eating healthy foods may help prevent some prostate cancers (MedlinePlus).

What has not been shown to help

• Selenium. In the SELECT trial, selenium alone or selenium with vitamin E did not lower the risk (NCI PDQ).
• Less fat, more fruit and vegetables. It is not known if these lower the risk of prostate cancer or of dying from it (NCI PDQ).
• Multivitamins. Regular use has not been proven to raise the risk of early prostate cancer, but a large study found a higher risk of advanced prostate cancer in men who took multivitamins more than seven times a week (NCI PDQ).
• Lycopene. Some studies link a diet high in lycopene to a lower risk and others do not. Lycopene supplements have not been proven to lower the risk (NCI PDQ).

Symptoms to report

Prostate cancer does not always cause symptoms, especially at first. When it does, MedlinePlus lists (MedlinePlus):

• Problems urinating, such as a weak stream, a stream that is hard to start or that starts and stops, suddenly needing to go, or going often, especially at night
• Pain or burning when urinating
• Blood in the urine or semen
• Pain in the lower back, hips or pelvis that does not go away
• Painful ejaculation

Many of these can come from other prostate problems that are not cancer, such as an enlarged prostate (BPH) (MedlinePlus) (NCI PDQ). The prostate symptom score helps you describe urinary symptoms to your provider, but it does not test for cancer.

What the USPSTF says about PSA testing

The US Preventive Services Task Force 2018 recommendation is still the current final version; an update is in progress (USPSTF 2018):

The USPSTF could not make a separate recommendation for Black men or for men with a family history. It says clinicians should tell them about their higher risk and about the benefits and harms of screening (USPSTF 2018). The prostate cancer screening age check compares this with the American Cancer Society guideline, the cancer risk calculator helps you find the right cancer check, and screening tests by age lists the other checks for your age.

Common questions

Does a high PSA mean I have prostate cancer?

No. A high PSA level may be a sign of prostate cancer, but many other things can raise it too. A biopsy is the only way to diagnose prostate cancer (MedlinePlus).

My father had prostate cancer. What should I do?

Tell your provider. A father, brother or son with prostate cancer raises your risk (NCI PDQ), and MedlinePlus says to talk about your prostate health with your provider if you are at high risk (MedlinePlus).