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American Medicine

Prostate cancer occurs in one of every six men in the United States.  It is the most frequently cancer diagnosed in men, and it results in one out of every nine cancer deaths in men.

Who is at higher risk of getting prostate cancer? It is

Some oral medicines can prevent prostate cancer, ask your doctor

well-known that having a family history of prostate cancer or being African-American results in a higher risk of prostate cancer.  Men with those characteristics are usually screened more intensively for prostate cancer, often beginning screening with PSA and being evaluated for prostate cancer symptoms starting at age 40.

But here is a new scoop for you. Two recent articles indicate that prostate cancer is also more frequent in families who have other hereditary cancer syndromes.  In men with HNPCC, the hereditary colon cancer family syndrome (commonly called the Lynch syndrome) which includes colon cancer as well as endometrial cancer, gastric cancer, pancreatic cancer, ovarian cancer, urinary tract cancers, brain cancer and certain skin tumors, the risk of prostate cancer was doubled.  The overall lifetime risk of prostate cancer in men who had a mutation in the genes causing Lynch syndrome was one out of every three men (V. Raymond and co-authors, J. Clinical Oncology 2013, Volume 31, Page 1713).

In addition, men who have gene mutations in the hereditary breast and ovarian cancer syndrome were found to have a higher risk of prostate cancer (up to eight-fold higher risk with BRCA2 mutation and three-fold higher risk with BRCA1 mutation). In addition to having a higher overall risk, if prostate cancer occurred, the cancer was more aggressive and therefore had a poorer survival (E. Castro, J. Clinical Oncology 2013, Volume 31, Page 1748).

So here are my tips for men (or your male friends or family):

• Knowing if you are at high risk of prostate cancer is important in deciding to have screening for the disease, which can result in improved survival according to some studies.
• Review whether your relatives have had cancers including colon cancer as well as uterus cancer, stomach cancer, pancreatic cancer, ovarian cancer, kidney or bladder cancers, prostate cancer, or brain cancer all of which would suggest the Lynch syndrome.  If you have these, discuss them with your physician and see if you should be tested for the Lynch gene mutations.
• Review is your relatives have had breast cancer, ovarian cancer or prostate cancers, all of which would suggest the hereditary breast and ovarian cancer syndrome.  If you have these, discuss them with your physician and see if you should be tested for the BRCA 1 or 2 gene mutations.
• If either of these are present, strongly consider beginning prostate cancer screening with PSA and digital rectal examination.  In those circumstances, beginning at age 40 may be appropriate.  Discuss this with your physician.
• Always remember if you have a family history of prostate cancer itself, or if you are African-American, your risks of cancer are higher and consider beginning prostate cancer screening with PSA and digital rectal examination at age 40.
• If you are at increased risk of prostate cancer, discuss prostate cancer prevention with your physician, including use of finasteride or cholesterol-related drugs such as statins, as well as nutrients such as tomatoes, pomegranates and green tea, to potentially reduce the risk of prostate cancer.
• If prostate cancer is diagnosed, be sure to consider carefully with your physicians (family doctor, urologist, radiation oncologist, and medical oncologist) whether you should have treatment or “watchful waiting”

For more information on risk assessment and preventing cancer, see my book, “Surviving American Medicine”.