Family history of prostate cancer: what it means and what to do

The prostate is a small, walnut-sized gland under the bladder and behind the penis. It produces the thick fluid that mixes with sperm to make semen. Prostate cancer starts when cells in the gland grow in an uncontrolled way, and the NHS notes that it mostly affects men over 50, although anyone with a prostate can get it.

A family history means one or more close blood relatives, such as a father or brother, have had prostate cancer. The NHS lists this as one factor that may give you a higher chance, and it is separate from age and ethnic background, both of which also affect risk. Having a relative with the disease does not mean you will develop it, but it is a good reason to know the symptoms and to talk to a GP.

Family history is also not only about prostate cancer. The NHS explains that a close relative with pancreatic, breast or ovarian cancer, particularly at a young age, can be relevant, because the same inherited genes, including a faulty version of BRCA2, can raise the chance of several cancers.

BRCA2 is best known in connection with breast and ovarian cancer, but the NHS states that a faulty BRCA2 gene also raises the risk of prostate cancer. Because genes are inherited from either parent, a faulty BRCA2 gene can come from your mother's side of the family as well as your father's, which is why doctors ask about breast and ovarian cancer in female relatives when assessing prostate cancer risk.

The NHS advises seeing a GP if you are over 40 and genetic tests have shown that you have a faulty version of the BRCA2 gene. For men in that group, PSA testing is the exception to the general rule that routine PSA testing is not offered.

If several relatives on one side of your family have had prostate, breast, ovarian or pancreatic cancer, or if they were diagnosed young, mention this to your GP. They can decide whether a referral to a genetics service is appropriate.

A PSA test is a blood test that measures prostate specific antigen. The NHS says high levels may be a sign of a prostate condition, and that testing may be recommended if you have symptoms that could indicate prostate cancer. A GP can discuss the benefits and risks with you, including the risk that a result is not accurate and that you may be offered tests and treatment you do not need.

Routine PSA testing is not currently offered on the NHS unless genetic tests have shown a faulty BRCA2 gene. However, the NHS says men and anyone with a prostate can ask a GP about PSA testing, and the GP will weigh up your cancer risk, including family history, to help decide whether the test is the right choice.

The NHS asks you to avoid anal sex, ejaculation, and exercise that leaves you out of breath, such as cycling, for 48 hours before the test, as these can raise PSA levels. If you have had a urine infection you should wait 4 to 6 weeks after it has cleared. Results usually take 1 to 2 weeks.

The NHS explains that prostate cancer usually starts on the outer part of the prostate, so it does not press on the urethra and cause symptoms until the cancer has grown or spread. When symptoms do occur, they can include changes to peeing:

• Difficulty starting to pee or straining to pee.

• A weak flow of urine, or "stop start" peeing.

• Needing to pee urgently or often, or both, including during the night.

• Feeling that you still need to pee just after finishing.

• Erectile dysfunction, or blood in your urine or semen.

• Lower back pain and unexplained weight loss, which can be signs of advanced disease.

These symptoms do not always mean cancer. The NHS says they can also be caused by an enlarged prostate, a very common non-cancerous condition that develops as men get older. But it advises seeing a GP if you have trouble peeing or other symptoms, if your symptoms change, get worse or no longer feel normal, or if you are worried about your risk.

At the appointment the GP will ask about your health and whether anyone in your family has had prostate, pancreatic, ovarian or breast cancer. They may carry out a rectal examination and may suggest a PSA test after explaining its benefits and risks. If your PSA is higher than normal, or the GP thinks the symptoms could be cancer, you may be referred urgently for further tests such as a biopsy and an MRI scan.

Knowing that your risk may be higher can cause worry. It helps to separate what is known from what is not: the NHS does not offer population screening, but it does offer a route to discuss your own situation, and symptoms are investigated promptly.

The NHS pathway runs through your GP and, if needed, a urology or genetics service. Some men choose private PSA testing or private MRI. These can be reasonable choices, but a result is only as useful as the advice that comes with it, because PSA levels can rise for harmless reasons, and your GP can help you decide what to do with a borderline result.