Family history: The most vital risk factor for prostate cancer

Family history is the most critical risk factor for prostate cancer. Men are more at risk if they had a father or brother with prostate cancer.

"Prostate cancer's reputation as the silent killer stems from the limited warning signs. Because of this, men must work closely with their doctors to identify all possible red flags from their family history," stressed Dr. David Samadi, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital.

It is important for men to know where they stand with prostate cancer. If your father or brother has prostate cancer, particularly if you also meet other risk criteria, make an appointment with a prostate cancer specialist. For high-risk men, that relationship should start long before diagnosis.

The Dr. Samadi Prostate Cancer Center also performs MRI Fusion Guided Biopsy to help men with an elevated PSA and to rule out prostate cancer. This technique has tremendously improved the detection and differentiation of high and low-risk prostate cancers. It integrates the use of an MRI, which makes for a much more accurate diagnosis, especially when it comes to the staging of prostate cancer.

Many studies have shown an increased importance of understanding and having a complete family history of prostate cancer. If an extensive family history exists and men are aware, it provides a wider range to estimate individual risks that are potentially more accurate than those based on typical family health histories. Both maternal and paternal history are equally important.

"The key is having a complete map of affected relatives. This will push patients and give a leg up to specialists towards making more informed screening, monitoring and treatment decisions," noted Dr. Samadi.

Not surprisingly, researchers at the University of Utah and Huntsman Cancer Institute found that having a first-degree relative such as a father or brother with prostate cancer increased the risk from 2.5 to 7.7 times more likely to develop the disease. Risks were also higher when a family member was diagnosed before age 50. Therefore if you have a close relative who had prostate cancer at a young age, you may be at risk for the same.

"Individualized care has always been the correct approach to diagnosing prostate cancer, but having a man's specific family history may prove to be inexpensive and an efficient addition to identifying men at the highest risk for this disease," said Dr. Samadi.

For most men, prostate cancer is a concern after the age of 55. However in a recent study of early onset prostate cancer out of the University of Michigan, it was found that genetics play a factor in prostate cancer diagnosis and aggression.

Early onset prostate cancer -- prostate cancer before the age of 55 -- was studied in comparison to prostate cancer at an older age. When comparing the two age groups, it was found that those with early onset prostate cancer diagnoses had a family history of the disease and also carried genes for a more aggressive form of the cancer. What was also noted was an increase in the number of cases over time. The number of prostate cancer diagnoses has increased from 5.6 cases per 100,000 in 1986 to 32 cases per 100,000 in 2008.

The study also noted the degree of prostate cancer related to age. It seems the younger the man, the more severe the prostate cancer and the higher the mortality rate. Men with prostate cancer who are aged 35 to 44 are nearly one and a half times more likely to die from the cancer than those aged 64 to 75. After the age of 80, the prognoses is again worse.

Linking back to the genetic factor, it appeared that many of the younger, more severe diagnoses had a family history.

In a recent review of the population impact of common familial cancers, Swedish researchers found that prostate cancer had the highest association between family history and disease risk. The assessment was based on the population attributable fraction (PAF), the preventable proportion of a disease in absence of a particular risk factor -- in this case, a family history of the cancer. Prostate cancer had the highest PAFs (13.94 percent), nearly double that of breast cancer (7.46 percent).