Prostate Cancer Risk Factors

A risk factor is anything that raises the chance of getting a disease. It is not a guarantee. Most men with several prostate cancer risk factors never get it, and some men with none of them do. Three things stand out as the strongest: age, race, and family history.

Prostate cancer is rare before age 40. After age 50, the chance rises quickly. About 6 in 10 prostate cancers are found in men older than 65. Age is the single strongest risk factor there is for this disease, and it is one you cannot change.

Black men, including men of Caribbean African ancestry, get prostate cancer more often than men of other races. They also tend to be diagnosed younger and to have more aggressive disease. Asian American, Hispanic, and Latino men have lower rates than non-Hispanic white men. Scientists do not fully understand why these differences exist. They likely involve some mix of genetics, health care access, and other factors still being studied.

Having a father or brother with prostate cancer more than doubles your risk. A brother's diagnosis raises risk more than a father's does. Risk rises further if multiple relatives were affected, or if a relative was diagnosed young. This points to shared genes, shared environment, or both.

A smaller group of men carry an inherited gene change that raises prostate cancer risk on its own. The most established is a mutation in BRCA1 or BRCA2 — the same genes linked to breast and ovarian cancer — with BRCA2 carrying the larger effect. Lynch syndrome, a condition that also raises colon and other cancer risks, raises prostate cancer risk too. If prostate, breast, ovarian, or colon cancer runs in your family, genetic counseling can clarify whether one of these is relevant to you.

Several other factors have been studied without a clear answer so far. Diets high in dairy or calcium show an uncertain link. Soy, coffee, and multivitamins have no consistent evidence either way. Obesity does not clearly raise overall prostate cancer risk, though some studies link it to more aggressive disease. Smoking has limited evidence tying it to prostate cancer death specifically. Chemical exposures such as arsenic or Agent Orange, prostate inflammation, and vasectomy have all been studied, with mixed or inconclusive results. None of these should be treated as settled risk factors the way age, race, and family history are.

You cannot change your age, race, or family history. What you can do is make sure your doctor knows about them, since they affect decisions about PSA testing and how early to start. If you have a strong family history or a known inherited mutation, ask about genetic counseling and earlier or more frequent screening discussions. General healthy habits — not smoking, staying active, keeping a healthy weight — are reasonable regardless, even though the direct link to prostate cancer risk is less clear-cut than for some other cancers.

The American Cancer Society ties its screening-conversation recommendations directly to these risk factors. Men at average risk should start the screening conversation at 50. Black men, and men with one father or brother diagnosed before age 65, are considered higher risk and are advised to start at 45. Men with more than one close relative diagnosed young are advised to start at 40. These are not ages to get a test automatically — they are ages to have an informed conversation with a doctor about whether testing makes sense for you.

• Given my age, race, and family history, when should I start talking about PSA testing?
• Does my family history suggest genetic counseling would help?
• Should my relatives be told about my diagnosis or risk factors, in case it affects their own screening?
• What symptoms should prompt me to call you, regardless of my risk level?

• American Cancer Society — Prostate Cancer Risk Factors
• U.S. Preventive Services Task Force — Prostate Cancer: Screening
• American Cancer Society — Screening Recommendations for Prostate Cancer