Family History, Race & Prostate Cancer

Feb 2017

Prostate cancer (PCa) is the commonest major cancer in UK men and second commonest cancer killer with over 47,000 new registrations and over 11,000 deaths each year. Despite this there is no national screening programme and controversy continues to surround our only effective frontline screening tool, the blood test PSA (Prostate Specific Antigen). Although NHS regulations clearly state that men aged 50-70 are fully entitled to receive a PSA test from their GP, most men are unaware of this and many are put off after inadequate counselling. Whilst this remains a problem for all men motivated to monitor as far as possible their own health, it is a particular problem for two groups of men that we know to be at higher risk than average.

The UK lifetime risk of developing PCa is about 1 in 8 for a white Caucasian man with a 3-4% risk of dying from it. However, for certain men within our population, that risk can more than double and, in our opinion, fully warrants proactive attempts to identify, forewarn and screen the men at risk. This applies most to black African or African Caribbean men who carry a 1 in 4 racially determined lifetime risk and to white men who have a family history of PCa or breast cancer.

Family history accounts for 5-10% of PCa cases and numerous studies have consistently shown that the risk is greatest for men with an affected father or brother or for those with a mother or sister carrying the BRCA breast cancer genes. The risk increases from roughly twice up to 5 times depending on the youth of the affected relative (eg father diagnosed below 60) and the greater number of brothers involved.

Given the high incidence and poor UK mortality rate from PCa, it really should be a priority for NHS health commissioners and GPs to acquire the easily collectable data on family history and race to ensure that these vulnerable men are made aware of both the risk and the NHS guidance that already exists for their protection.