There are three well-established risk factors for prostate cancer:
- Older age
- Family history (including genetics)
- Black race
As men age, their risk for prostate cancer increases considerably. About 60% of prostate cancer is diagnosed in men over age 65. That is why talking with your doctor about PSA screening for prostate cancer as you enter middle age is so important.
Genes for disease can run in families. Of all the major cancers, prostate cancer is the most heritable: 58% of prostate cancer is driven by genetic factors. Men who have a close relative with prostate cancer may be twice as likely to develop the disease, while those with 2 or more relatives may be nearly 4 times as likely to be diagnosed. The risk is higher if the affected family members were diagnosed before age 60.
As we unlock the genetic underpinnings of cancer, we see that men may also be at increased risk of prostate cancer if they have a strong family history of other cancers, such as breast cancer, ovarian cancer, colon cancer, or pancreatic cancer.
Because family members share many genes, there may be multiple genetic factors that contribute to the overall risk of prostate cancer in a family. However, there are also some individual genes (such as BRCA2) that we now know increase the risk of prostate cancer if certain changes (mutations) are present in the gene. Men with these gene mutations may need to be screened differently.
One in six Black men will be diagnosed with prostate cancer in their lifetime (compared with one in eight white men), and they are more than twice as likely to die from it. They are also more likely to be diagnosed at a younger age, and with more aggressive disease.
Although there is clearly a disproportionate number of Black men who are diagnosed with prostate cancer, the increased death rate from prostate cancer has been shown to be due in part to inequality in access to healthcare, insurance, PSA screening, appropriate treatment and follow-up, and other socioeconomic factors. There is ongoing research to try to identify whether there are biological differences in cancers that develop in Black men so that we can improve treatment. It is also important to realize that not every Black man will get prostate cancer, and that prostate cancer has a better chance of being managed effectively and cured if it is detected early.
Download or request a copy of the guide, Additional Facts for Black Men and Their Families.
Other risk factors for prostate cancer diagnosis and worse outcomes are social and environmental factors—particularly a diet that is low in vegetables and high in processed meat and saturated fat—and lifestyle. Men who are overweight or obese are at greater risk of developing an aggressive form of prostate cancer. Research has shown that in obese men, recovery from surgery tends to be longer and more difficult, and the risk of dying from prostate cancer can be higher.
Risk Factors in Aggressive vs. Slow-Growing Cancers
In the past few years, we’ve learned that prostate cancer really is several diseases with different causes. More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.
For example, while smoking does not appear to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer. Likewise, lack of vegetables in the diet (especially broccoli-family vegetables) is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.
Body mass index, a measure of obesity, is not linked to being diagnosed with prostate cancer overall. In fact, obese men may have a relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume. However, obese men are more likely to be diagnosed with aggressive disease.
Other factors that have been linked to aggressive prostate cancer include:
- Tall height
- Lack of exercise and a sedentary lifestyle
- Very high calcium intake
- Black race
- Family history
- Agent Orange exposure
Research in the past few years has shown that dietary factors might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease. Get practical tips on dietary and lifestyle changes in PCF’s guide, The Science of Living Well, Beyond Cancer.
Risk and Other Prostate Conditions
A common misconception is that the presence of non-cancerous conditions of the prostate will increase the risk of prostate cancer.
While these conditions can cause symptoms similar to those of prostate cancer and should be evaluated by a physician, there is no evidence to suggest that having either of the following conditions will increase a man’s risk for developing prostate cancer.
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate. Because the urethra (the tube that carries urine from the bladder out of the body) runs directly through the prostate, enlargement of the prostate in BPH squeezes the urethra, making it difficult and often painful for men to urinate. Learn more about BPH.
Prostatitis, an infection in the prostate, is the most common cause of urinary tract infections in men. Most treatment strategies are designed to relieve the symptoms of prostatitis, which include fever, chills, burning during urination, or difficulty urinating. There have been links between inflammation of the prostate and prostate cancer in several studies. This may be a result of being screened for cancer just by having prostate-related symptoms, and currently, this is an area of controversy. Learn more about prostatitis.
More Myths and Non-Risks
Sexual Activity: High levels of sexual activity or frequent ejaculation have been rumored to increase prostate cancer risk. This is untrue. In fact, studies have shown that men who report more frequent ejaculations may have a lower risk of developing prostate cancer.
Vasectomy: Having a vasectomy was originally thought to increase a man’s risk, but this has since been disproven.
Medications (aspirin, statins): Several recent studies have shown a link between aspirin intake and a reduced risk of prostate cancer by 10-15%. This may result from different screening practices, through a reduction of inflammation, or other unknown factors. The class of drugs called statins – used to lower cholesterol – has also recently been linked to a reduced risk of aggressive prostate cancer in some studies. However, neither aspirin nor statins are recommended solely to prevent or treat prostate cancer.
Alcohol: There is no known direct link between alcohol and prostate cancer risk.
Supplements (Vitamin E, selenium): Recent studies have not shown a benefit in consumption of vitamin E or selenium (in the formulations studied) in the prevention of prostate cancer.
(Some of the information on this page is adapted from Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.)