SUMMARY:
A family history of prostate cancer is a major risk factor for the disease, although only an average of 10% or less can be directly linked with an inherited gene. Other cancers can also contribute to an inherited mutation. It is important for prostate cancer patients to know their family history, to share it with their doctors, and to embrace a healthy lifestyle that supports functioning repair genes.
Is family history a big risk factor for prostate cancer?
Most prostate cancers are not known to be inherited. However, family history is a big risk factor for prostate cancer. The National Cancer Institute goes further, calling it a major risk factor. That’s because the hereditary genes connected with prostate cancer are passed down from one generation to the next.
When prostate cancer occurs across generations, it is called familial or hereditary prostate cancer. It is estimated that between 10-20% of prostate cancer cases are familial. According to Massey Comprehensive Cancer Center, about 5-10% of all prostate cancers can be “attributed to a cancer susceptibility gene that is inherited as a dominant trait.” (Note that in the 0.5% of patients younger than 55, the number of cases attributable to a dominant gene is closer to 45%, but this is rare.)
A man with a first-degree relative (father, son, brother) has a greater chance of being diagnosed with prostate cancer than a man who does not. In fact, statistical comparisons show that in some cases the odds are greater than others. This is called relative risk (that is, risk in relation to a control group).
Here are some examples of higher chances vs. a man with no family history of prostate cancer:
- A man whose father was diagnosed at any age has average 2.35 times more chance
- A man with a brother(s) diagnosed at any age has average 3.14 times more chance
- A man with one first degree relative diagnosed at any age has average 2.48 times more chance
The more family members who had prostate cancer, the higher the odds. However, age at diagnosis also makes a difference in relative risk. If the affected member was diagnosed younger than 65 years, the relative risk goes up; if the member was 65 or older at diagnosis, the relative risk goes down.[i] Thus, the more family members and the younger the age, the greater the risk.
Are there other cancers known to play a part in prostate cancer risk?
Yes, hereditary prostate cancer risk is closely linked with hereditary breast cancer (appears across generations). The two cancers appear interrelated. If either prostate or breast cancer appears in a family line, the odds suggest that the other will also show up.
In a 2018 paper, Barber et al. explain,
Those with familial breast cancer had a 21% greater risk of prostate cancer overall and a 34% greater risk of lethal disease. Family history of prostate cancer alone was associated with a 68% increased risk of total disease and a 72% increased risk of lethal disease. Men with a family history of both cancers were also at elevated risk.[ii]
The most common driver of hereditary breast cancer is either of two genes, BRCA1 and BRCA2. These genes can be passed on to sons as well as daughters. If a male who carries either gene develops prostate cancer, it tends to occur earlier and behave more aggressively.
Are there any other hereditary cancers associated with higher prostate cancer risk?
BRCA1 and BRCA2 are linked with three other cancers: ovarian, pancreatic, and male breast cancer. Therefore, a family history of these cancers may warrant genetic testing in men whose first-degree relatives had such cancer.
Also, there are certain familial lines of colorectal and endometrial (uterine lining) cancers that are linked with specific gene mutations. They are less common, but genomic analysis has identified them in some prostate cancer cases.
What should I do if I have a family history of prostate cancer or any of these?
The first thing is what NOT to do. Don’t panic. The science of genetics and the understanding of the biology of cancer behavior is better than ever, early detection is possible, advanced treatments are available, and research is ongoing.
Now that you know what not to do, if you have a family history here are positive action steps:
- Keep in mind it’s the minority of cancers (usually less than 10%) that are inherited. The majority of cancers can be traced to tobacco, unhealthy diet, obesity, alcohol use, and toxic exposure. Developing a cancer does not necessarily mean it was inherited.
- Start now to learn your family’s health history in as much detail as possible. If you don’t ask, you may never know. If you’re not sure how to ask questions, the Dana-Farber Cancer Institute offers a conversation guide.
- Share what you learn with your primary care doctor. He/she may recommend genetic testing.
- If you test positive for gene mutations linked with your family’s cancer history, consider genetic counseling.
- Your doctor can recommend appropriate screening tests and the frequency. The earlier cancer is detected, the more options there are and the greater the chance for success.
- If you don’t know your family history (e.g. you were adopted) talk to your doctor about genetic testing as a first step toward peace of mind.
- Inform your children and siblings if you develop a familial cancer. If you are a male carrier of genes such as BRCA1 or BRCA2, your daughters will be at higher risk for breast, ovarian and endometrial cancers; your sons will be at higher risk for prostate and male breast cancers.
Remember that a family history of prostate cancer or any other cancer is not a sentence of doom. In fact, you can make choices that can improve your genetic outcomes. Dr. Dan Sperling devoted a blog specifically to the research of Dr. Dean Ornish. He and his team have demonstrated that a combination of healthy nutrition, exercise, stress management, and social support can actually change the activity of your genes. Pick up the reins of wellness and take charge of your health. You have more gene power than you think.
Frequently Asked Questions
Q: How many gene mutations are linked to prostate cancer?
A: A 2023 multicenter study identified 11 genes associated with prostate cancer. Three of them (BRCA2, ATM and NBN) were significantly linked with aggressive prostate cancer. Their findings “suggest that DNA repair and cancer susceptibility genes can inform disease management in men with nonaggressive prostate cancer, as men carrying deleterious variants in these genes are likely to develop advanced disease.” Many other gene variants are under investigation.[iii]
Q: What are repair genes?
A: DNA is the molecule that is like our owner’s manual for life. Among other things, it holds key instructions for duplication, because when cells make copies of themselves, the copies must be exact. However, like anything else, life brings wear and tear. Cancer largely occurs due to breakdowns in DNA copying during cell duplication. DNA contains repair genes that are programmed to detect and fix these “errors.” For instance, BRCA1 is a repair gene, but if it ceases to function properly, a cancer cell could get out of control. As a general principle, the healthier you live, the less wear and tear you place on your body, and the more “fit” your repair genes are to prevent cancer from starting.
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated March 2026.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Kiciński M, Vangronsveld J, Nawrot TS. An epidemiological reappraisal of the familial aggregation of prostate cancer: a meta-analysis. PLoS One. 2011;6(10):e27130.
[ii] Barber L, Gerke T, Markt SC, Peisch SF et al. Family History of Breast or Prostate Cancer and Prostate Cancer Risk. Clin Cancer Res. 2018 Dec 1;24(23):5910-5917.
[iii] Darst BF, Saunders E, Dadaev T, et al. Germline Sequencing Analysis to Inform Clinical Gene Panel Testing for Aggressive Prostate Cancer. JAMA Oncol. 2023;9(11):1514–1524.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
