Prostate cancer in the family – when is it time to start getting tested?

When a father, brother or several men in the family have had prostate cancer, the same question is often raised: does the usual advice also apply to me, or should I start getting tested earlier? For many, the question comes long before any symptoms appear. At that time, it is easy to fall between worry and uncertainty, especially since PSA testing can be both helpful and has clear limitations.

Prostate cancer in the family - when should you start getting tested?

Prostate cancer is the form of cancer where heredity plays the biggest role in many men. The risk increases if you have a father or brother with prostate cancer, and even more so if several close relatives have had the disease or if someone was diagnosed at a relatively young age. Sons of men with prostate cancer have about 1.5–2 times higher risk than average, and brothers have about 2–3 times higher risk. In families where both the father and brother are affected, especially if someone was diagnosed before the age of 70–75, your own risk may be clearly increased.

When is prostate cancer in the family considered a hereditary risk?

Having “prostate cancer in the family” is not the same as belonging to a clear hereditary risk group. A single case in an older relative is common and does not automatically mean that you need to start early testing. What matters most is how close the relative is to you, how many people have been affected and at what age the disease was discovered.

The hereditary risk group includes men who have a father or brother with prostate cancer and at least one other first-degree relative in the same branch of the family with the disease, where someone was diagnosed before the age of 75. This also includes men with mutations in BRCA2 or HOXB13. Special follow-up is recommended for these groups.

A concrete example is if your father had prostate cancer at the age of 78 but no other close relative is affected, it is not certain that you belong to the clear hereditary risk group. However, if both your father and your uncle had prostate cancer, and one of them was diagnosed before 75, the picture is different. Then there is reason to discuss earlier testing.

When should you start testing to see if you have a family history of prostate cancer?

For men in a hereditary risk group, PSA testing should be performed from the age of 40, and then continued follow-up as long as curative treatment would still be relevant if cancer were discovered.

For men without a clear hereditary risk, PSA testing is recommended from the age of 50 if they wish, provided that they have been informed about both the pros and cons and have an expected remaining life expectancy of more than 10 years.

You should consider PSA testing if you are over 40 and have at least two close relatives with prostate cancer. At the same time, it is stated that men under 50 should generally be advised against PSA testing, except in the case of hereditary risk groups.

In practice, this means:

• If you have two or more close relatives with prostate cancer, it may be reasonable to start discussing testing as early as the age of 40.
• If you have a single close relative with prostate cancer, especially if the diagnosis came late in life, it is more often appropriate to take a position as you approach 50.
• If there is a known BRCA2 mutation in the family, the issue should be addressed even more actively, since the genetic risk is higher.

It is emphasized that men with risk factors and a life expectancy of more than 15 years may be eligible for early diagnosis after an informed decision, and that a family history of high-risk mutations should lead to consideration of genetic testing.

What does a PSA test mean, and why is the test not enough on its own?

PSA is a protein that is produced in the prostate and measured in the blood. An elevated value can be due to prostate cancer, but also to benign prostatic hyperplasia or inflammation and infection in the urinary tract or prostate. A PSA test is therefore not a yes-or-no test for cancer.

A normal PSA value does not rule out all cancer, and an elevated value does not automatically mean that you have cancer. Prostate cancer testing uses PSA as the first step, and in case of elevated values, it is continued with an MRI and sometimes tissue samples to better distinguish between harmless and treatment-requiring changes.

For you as an individual, the most important point is that PSA is not just about "taking a blood sample". In some cases, the test starts an investigation that can provide clear answers, but which can also lead to the discovery of small tumors that would never have caused problems.

Which symptoms should you take seriously, even if you are already planning testing?

Early stages of prostate cancer often do not cause any symptoms at all. Therefore, heredity can be the first signal to consider testing. But symptoms should always be assessed as a separate issue and not wait until the next scheduled PSA test.

Seek care if you experience new symptoms such as a weak urine stream, frequent urges, difficulty emptying the bladder, blood in the urine or semen, bone pain without a clear explanation or unexplained weight loss. These symptoms do not necessarily mean cancer, as benign prostatic hyperplasia is much more common, but they still need to be investigated medically.

A common patient scenario is the man who thinks: “I’ll get tested next year anyway.” That reasoning only works if you are symptom-free. In the event of symptoms, you move from preventive testing to actual diagnosis, and then healthcare should be contacted immediately.