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While the controversy concerning the recommendation for men to forego regular PSA (prostate-specific antigen) testing for prostate cancer, issued by the US Preventive Services Task Force, still rages on, it’s easy to overlook an important group of men: those at high risk for prostate cancer. All men need to take control of their own healthcare, fully inform themselves about the risks of getting prostate cancer, and then ask themselves, “Am I at high risk for prostate cancer?” and if they are, they need to get tested.
Although there are about a dozen known or suspected causes and risk factors for prostate cancer, not all of them are equally critical when it comes to the possibility of developing, dying of, or having a more aggressive form of the disease. Men who meet any one or more of these three risk features include the following.
Being African American
Prostate cancer develops about 60 percent more often among African American men than it does in white American men. Black men are also more likely to be diagnosed with more advanced prostate cancer than are white men, and they also may be more likely to develop aggressive disease. For all of these reasons, the PSA test for prostate cancer among African American men is strongly recommended and should begin at age 40.
Some African American men also appear to be at greater risk of prostate cancer because of a genetic trait that makes them absorb more calcium than normal. Therefore in this subgroup of African American men, calcium increases their prostate cancer risk.
As a side note, it should be noted that despite the fact that black men are at high risk for prostate cancer, only about 4 percent of the subjects in the Task Force’s case study–upon which it made its recommendation concerning PSA testing–were black.
Any man who has a relative with prostate cancer is at higher risk for the disease. According to the American Cancer Society, having a father or brother with prostate cancer more than doubles your risk for developing the disease. The risk appears to be greater if your brother has prostate cancer than if your father has the disease. A man’s risk of developing prostate cancer is even greater if he has multiple family members with the disease and the prostate cancer developed at a young age. The bottom line is, men with a family history of prostate cancer should start getting tested at age 40.
Exposure to Agent Orange
During the Vietnam War between 1962 and 1971, tens of thousands of men were exposed to Agent Orange, a now-banned chemical defoliant. Research shows that those men have greatly increased risks of prostate cancer and an even higher risk of developing the most aggressive form of the disease when compared with men who were not exposed to Agent Orange. Several studies have reported a twofold increased risk of prostate cancer among men exposed to Agent Orange, and a University of California-Davis study noted that exposed vets were diagnosed 2.5 years younger and were nearly four times more likely to have metastatic cancer than men not exposed.
Although men who served in the Vietnam War are already age 60 and older and hopefully have already had a PSA test, it’s important that this population of men be screened if they have not already done so, and to continue regular screening given their elevated risk of prostate cancer.
Other risk factors for prostate cancer
Although the three abovementioned risk factors are associated with a significantly greater risk of prostate cancer and thus are reasons for men to pursue PSA testing if they meet the criteria, there are other risk factors that all men should consider when making a decision about getting screened for prostate cancer. Here is a brief review of those risk factors.
- Age: Men age 65 and older are at greatest risk of developing prostate cancer.
- Genetics: Five to 10 percent of prostate cancer cases are believed to be associated with inherited changes in the DNA.
- Diet: A higher risk of prostate cancer has been associated with a diet that is high in fat, red meat, calcium, and dairy foods.
- Exercise: Regular exercise has been shown to reduce the risk of prostate cancer, including aggressive prostate cancer.
- Chemical exposure: Besides Agent Orange, exposure to pesticides and other chemicals such as those associated with occupations like farming or painting, as well as bisphenol-A (BPA) and other environmental toxins have been associated with an increased risk of prostate cancer.
- Obesity: Although the exact role of obesity in prostate cancer is not fully understood, it is known that obesity has an impact on hormone levels (including testosterone and estrogen), and that being overweight is a risk factor for diabetes and metabolic syndrome, both of which may be associated with prostate cancer.
- Testosterone: Testosterone has a role in prostate cancer, although it is a hormone imbalance and not testosterone alone that is of concern.
- Inflammation: Studies show inflammation is a risk factor for a number of diseases, including prostate cancer, because it has a role in damaging DNA.
All men should take a personal inventory and ask themselves, “Am I at high risk for prostate cancer?” If the answer is “yes,” then get tested. Even if the answer is “no,” it’s wise to be fully informed of all the risk factors and your options.
Read more in our Prostate Cancer Health Center.
Chamie K et al. Agent Orange exposure, Vietnam War veterans, and the risk of prostate cancer. Cancer 2008 Nov 1; 113(9): 2464-67
Schecter A et al. Agent Orange exposure, Vietnam war veterans, and the risk of prostate cancer. Cancer 2009 Jul 15; 115(14): 3369-71