What are the odds that a man will develop prostate cancer (PCa) if he has no family history of the disease, is in otherwise good health, has not been exposed to toxic substances, and is not in a demographic group with higher PCa statistics? On average, a man has about a one chance out of nine that he will have the disease. Not bad, considering that when found early practically no one dies of it. In fact, PCa has incredibly better odds than, say, Russian Roulette, where you have a 1 in 3 chance of dying!
Family history and your genes
However, two genetic variables that can bump up your chance of being diagnosed with PCa. The first has to do with first-degree relatives, which includes parents, siblings, and children. (Second-degree relatives include grandparents, grandchildren, uncles, aunts, nephews, nieces, and half-siblings while third-degree relatives include great-grandparents, great grandchildren, great uncles/aunts, and first cousins.) Thus, a man with a father, brother or son with PCa has two-to-three times the risk of someone with no first degree relative with a history.
But it doesn’t stop there. The risk level increases with more family members who have PCa. For example, three generations in a row with a history of PCa on either the mother’s or father’s side will boost the probability by strongly suggesting an inherited vulnerability for the disease.
The second variable is a family history in which there is some prostate cancer as well as other cancers (e.g. breast cancer, pancreatic cancer, etc.). While a linear connection may not be apparent in the family tree, it is reasonable to assume that the broader gene pool raises the odds of PCa and other cancers.
As knowledge grows, so do healthy strategies
The above picture may appear somewhat bleak, but there is plenty of room for hope. Each day scientists and researchers are learning more about specific genes and chromosome regions linked with PCa. Today, we have accurate tests available for genomic biomarkers to help us identify how dangerous an individual’s PCa might be. This is especially important for men who may be carrying an inherited propensity for this disease. If diagnosed with PCa, genomic testing is a potential lifesaver that can point to a need for immediate aggressive treatment, and be closely followed afterward.
There’s even better news as we continually discover ways that healthy lifestyle changes can actually modify how cells, the immune system, and the body’s information pipelines will behave. There is an expanding body of research on how diet, supplements, exercise, meditation, stress management, etc. can influence programming at the level of individual genes. For example, in 2011 Dean Ornish wrote, “Here’s some very good news: your genes are not your destiny. Earlier this week, my colleagues and I published the first study showing that improved nutrition, stress management techniques, walking, and psychosocial support actually changed the expression of over 500 genes in men with early stage prostate cancer.”[i]
Your family history: what you should do
It isn’t always easy to obtain details of your parents’ and siblings’ health, let alone that of more remote ancestors. It is important, however, to get as much information as you can about familial health patterns for as far back, and as generationally broad, as possible. There are more internet sites than ever to help trace family genealogy (your family tree), but many circumstances such as adoptions or lost records due to wars, emigrations, etc. certainly pose obstacles.
Still, it is exciting and enriching to learn about your genetic strengths, and empowering to learn about your areas of vulnerability that you can do something about.
Staying ahead of the odds
If you already know, or find out, that your hereditary background offers clues to your personal increased chances of prostate cancer, there are powerful resources for detecting it early and characterizing it genomically. If you know you’re at risk genetically, start with an annual PSA test that includes all PSA variants, and regardless of your age, and talk to your doctor about having a baseline multiparametric MRI (mpMRI) scan of the prostate. This gives you and your doctor a detailed 3D anatomic portrait of the prostate gland and surrounding area, and provides valuable information about the characteristics of tissue in each of the prostate zones. Together, both tests serve as a basis for comparing future blood tests and, if indicated, subsequent mpMRI scans. Note that there are a minority of dangerous PCa cell lines that do not cause an increase in PSA, so request information about additional tests for blood or urine biomarkers.
What’s at stake is the possibility of being diagnosed too late for a potentially curative treatment. Following the healthiest lifestyle in the world cannot prevent all cancers, especially if there’s what’s called a genetic load. The key is to catch PCa, or any cancer, in its early stages when there is still a potentially curative window. Follow this simple plan: learn about your family medical history, establish a PSA and mpMRI baseline starting at age 40 if you have a first-degree relative with PCa, talk with your doctor about the merits of biomarker testing, and monitor according to your doctor’s protocol. You were born with your genes, but what you do with them is up to you.
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.
[i] Ornish, Dean. “Changing your lifestyle can change your genes.” PAACTUSA. Dec. 3, 2015. http://paact.help/changing-your-lifestyle-can-change-your-genes-dean-ornish-md-2011/