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Risk factors are things that raise your chances of getting a disease. For each person, there’s a mix of genetic, biological and lifestyle factors that play a part in prostate cancer risk. About 1 in 10 men with advanced prostate cancer has a genetic change (mutation) that was passed down in his family (inherited) and can increase prostate cancer risk. Fred Hutch Cancer Center researchers are working to learn more about these genetic changes. Our Prostate Cancer Genetics Clinic helps patients and families learn about their risk.
Age is the main risk factor for prostate cancer. Your risk goes up as you get older. Other factors matter, too. Prostate cancer is more common in African American men than white men and less common in Asian or Hispanic/Latino men. Though it’s not yet clear why race and ethnicity are connected to risk, researchers are looking into the reasons. It may have to do with genetic and biological factors. But there may be other causes, like differences in access to health care.
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Genetic and Biological Risk Factors for Prostate Cancer
Many of the risk factors for prostate cancer are things you can't change. But it’s still important to be aware of them because they may affect your prostate cancer screening plan, like when you should start having screenings.
- Age: Prostate cancer can occur at any age. But it is most often found in men over age 50 and more than two-thirds of men diagnosed with the disease are over 65.
- Family history and genetics: A family history of prostate cancer may indicate increased risk for you. This is most true if you have close relatives younger than 60 when diagnosed. If your father or brother had prostate cancer, your risk is two to three times greater than if you had no family history of the disease. If you have a family history of other cancers, your risk for prostate cancer might be higher as well.
- Race or ethnicity: African American men are more likely than men of other races to develop prostate cancer. They’re also more likely to get prostate cancer at an earlier age, to have more aggressive and advanced disease at the time of diagnosis and to die from prostate cancer. The disease is less common among men of Asian or Hispanic/Latino descent than among those of European descent.
- Hormone levels: Research suggests that prostate cancer is linked to higher levels of certain hormones, such as testosterone, the main male sex hormone. An enzyme in the body changes testosterone into dihydrotestosterone (DHT). DHT is important for normal prostate growth. But it may also play a role in prostate cancer.
Lifestyle Risk Factors for Prostate Cancer
There are some factors you can control that may raise or lower your risk for prostate cancer. Prostate cancer is most common in North America, northwestern Europe, Australia and the Caribbean and less common in Asia, Africa and Central and South America. Lifestyle differences may be one reason why.
- Diet: Scientists believe diet is an important factor in prostate cancer risk, but the links are not clear. A diet high in fat (such as in meat and dairy) and calcium and low in fruits and vegetables may increase risk. Vitamin E and folic acid supplements are also thought to increase risk.
- Obesity: Studies have not shown a clear link between obesity and prostate cancer. But in some studies, obese men have had lower risk of getting a low-grade form of the disease and higher risk of getting a more aggressive form. Several studies have found that obese men may be at greater risk of having more advanced prostate cancer and of dying from prostate cancer.
- Smoking: Middle-aged men who are long-term, heavy smokers face twice the risk of developing more aggressive forms of prostate cancer than men who have never smoked.
- Exercise: Studies have found that people who get regular exercise have a slightly lower risk of prostate cancer. Exercise may lower the chances of prostate cancer being aggressive or fatal.
Scientists have also studied if risk goes up from having an inflamed or enlarged prostate, having a vasectomy, being exposed to radiation or having a sexually transmitted virus. At this time, there is little evidence that these factors add to risk.
How to Assess Your Genetic Risk for Prostate Cancer
Genetic testing may show if you have certain gene changes that can be passed down in families that increase the risk of prostate cancer. Testing usually involves taking a small sample of blood or saliva. If you have a family history of prostate cancer or certain other risk factors, ask your health care team if it’s a good idea to get tested. They will consider your personal health history and your family health history before making a recommendation.
A registry called PROMISE is one part of our effort to understand how genes affect prostate cancer risk. PROMISE stands for Prostate Cancer Registry of Outcomes and Germline Mutations for Improved Survival and Treatment Effectiveness. Heather Cheng, MD, PhD, a medical oncologist at Fred Hutch and leading expert in inherited genetics of prostate cancer risk, leads PROMISE. Through the registry, men with prostate cancer can get tested for 30 cancer risk genes. The goal is to clarify why some patients respond to certain treatments and others don’t. Testing can also provide information for other family members who might have the same genes.
The Prostate Cancer Genetics Clinic at Fred Hutch also offers genetic counseling and genetic testing to men who already have prostate cancer. The results may help us predict how fast their cancer will grow, how likely it is to spread and which treatments they need. If tests show a patient has a gene change linked to inherited cancer risk, we can help refer his relatives for genetic counseling and testing, and we can connect them with our high-risk prevention program.
Cheng, who directs the Prostate Cancer Genetics Clinic, explained why knowing your risk for inherited cancers matters. “The sooner you have the information, the sooner you can stay on top of it,” she said. “You may have options to screen for cancer earlier or more closely. If you do develop cancer, you may be able to manage it at an earlier stage when it is more likely to be cured. Your doctor may also be able to offer more personalized treatment options."
Learn more about if you should be tested and how we can help.
How Prostate Cancer Can Be Prevented
Physicians don’t know the exact cause of prostate cancer, and many prostate cancer risk factors cannot be controlled. So, it’s not possible to prevent the disease. But there are some things you can do, such as a healthy diet and exercise, that may help lower your risk.
The exact role of diet in prostate cancer is still unknown, but many of the foods thought to lower the risk are plant-based foods. Men who eat a lot of red meat or high-fat dairy products and fewer fruits and vegetables appear to have a slightly higher risk. Researchers continue to look for clear links. They are also studying if men can reduce their risk by exercising or taking certain dietary supplements.
How Fred Hutch is Researching Prostate Cancer Prevention
Fred Hutch has been involved in a wide range of studies on how to prevent, detect and treat prostate cancer. We played a key role in The Prostate Cancer Prevention Trial. This national trial found that the medicine finasteride cut the risk of developing prostate cancer by almost 25%. Later, biostatistician Joseph Unger, PhD, MS, led a study that showed finasteride could protect men from developing prostate cancer for up to 16 years. Our researchers have also studied diet and supplements, looking for ways men can lower their risk.
The Institute for Prostate Cancer Research, a collaboration between Fred Hutch and UW Medicine, continues to study potential preventive agents and strategies.
A study called the Prostate Cancer Prevention Trial showed that the medicine finasteride reduced the risk of developing prostate cancer by 25%. Finasteride is approved to treat benign prostatic hyperplasia (enlarged prostate, not cancerous). In another study, a similar drug, dutasteride, was also found to reduce the risk of prostate cancer in men at higher-than-average risk for the disease.
But there are potential side effects. Also, men who got prostate cancer while on these medicines were slightly more likely to have higher-grade cancer. So, finasteride and dutasteride have not been approved by the U.S. Food and Drug Administration for cancer prevention.
Most research suggests that food is the best source of nutrients. Eating a balanced diet is better than taking supplements. Supplements can have both risks and benefits. Some studies show that taking certain supplements in high doses may have negative effects. In fact, because of a large clinical study known as SELECT, we recommend prostate cancer patients do not take vitamin E or selenium supplements.
If you avoid specific groups of foods, you may need to take a supplement to get some of the nutrients that foods supply. Before starting supplements, talk with a registered dietitian and your care team about your exact needs.