Is Prostate Cancer Genetic? Here’s How Family History Affects Your Inherited Risk

Prostate cancer is a health condition where your prostate cells grow abnormally. It’s one of the most common cancers worldwide, affecting over 12% of men in the U.S. during their lifetime. So the chances are, you or someone you know is affected. 

Though we don’t know exactly what causes prostate cancer, we do know that it’s related to your genes (DNA). 

There are two different ways that genes play a role in prostate cancer:

1) Familial prostate cancer: This means prostate cancer runs in your family, but it isn’t caused by a specific inherited gene. It may be related to a combination of different genes, your environment, or other factors. Familial prostate cancer makes up about 20% of all prostate cancers.

2) Hereditary prostate cancer: This means your family has specific cancer-causing genes that can be inherited (passed down from parent to child). Inherited genes play a role in 5% to 10% of all prostate cancers. 

Read on to learn more about prostate cancer, and how your family history and inherited genes affect your risk.

How do genes cause cancer?

Cancer is a health condition where your body cells grow in an abnormal way.

Your body cells contain genes — small sections of DNA. Genes control how your cells function and behave. Sometimes, your genes can change (or “mutate”). These gene changes can make your cells grow and behave abnormally, leading to cancer. 

How do you get a genetic mutation?

You can end up with a mutation of your genes in two different ways:

1) You’re born with it. This is called an “inherited'' gene mutation. An inherited gene mutation is passed down to you by your mother or father. Keep in mind that both women and men can carry these mutations.

2) You acquired it at some point during your life. This is called an “acquired” gene mutation. This means you were born without the gene change, and it happened at some point during your life. 

Does prostate cancer run in families?

Yes. Prostate cancer can run in your family. This is called “familial prostate cancer.” It means that multiple people in your extended family have prostate cancer, but it’s not caused by specific inherited genes. 

If you have family members with prostate cancer, your own risk goes up. Having a first-degree relative (like a brother or a father) with prostate cancer makes you 2 to 3 times more likely to get it yourself. And your risk goes up even higher if you have multiple relatives with prostate cancer — especially if they were young when diagnosed. 

How do inherited genes affect my risk for prostate cancer? 

Inherited genes are passed down from parent to child. Some of these genes can make you more likely to get prostate cancer. This is called “hereditary prostate cancer.”

There are over 20 different inherited gene mutations associated with hereditary prostate cancer:

• BRCA1 and BRCA2

• CHEK2

• ATM

• PALB2

• RAD51D

• DNA mismatch repair genes (like MSH2, MSH6, and others)

• RNASEL (also called HPC1)

• HOXB13

Some mutations that cause hereditary prostate cancer can also cause other types of cancer, like breast, colon, pancreatic, and ovarian. So even if no one in your family has prostate cancer, it’s still possible to inherit a gene mutation that’s linked to prostate cancer.  

If I inherit a genetic mutation, will I definitely get cancer?

No. A genetic mutation can increase your risk of getting prostate cancer, but having one does not mean you will definitely get cancer. Some people with genetic mutations will never develop prostate cancer. 

How do BRCA1 and 2 mutations affect my risk of getting prostate cancer?

BRCA1 and BRCA2 are types of genes called “tumor suppressor genes.” These genes normally help your body repair mistakes in your DNA and tell your cells when to grow and die. 

If you have a mutation in these genes, it can make it easier for cancer cells to grow in your body. 

Inherited BRCA1 and BRCA2 mutations are especially well known for causing breast and ovarian cancer in women. But they can also cause prostate cancer — especially if you have the BRCA2 mutation. A person with a BRCA2 mutation is 3 to 4 times more likely to get prostate cancer, particularly more aggressive forms. If you have this mutation, screening and early detection are especially important.

Is hereditary prostate cancer more aggressive?

It’s not clear. There’s some evidence that hereditary prostate cancer might be more aggressive or widespread, especially in people who have a BRCA2 mutation. More research is needed in this area. 

Other genes (like HOXB13) can increase the risk of prostate cancer in families, but they aren’t necessarily linked to more aggressive cancer. 

How can I tell if I inherited a genetic mutation?

To determine if you may have inherited a genetic mutation, you can get genetic testing done. Genetic testing uses your blood or saliva to look for certain gene changes associated with prostate cancer. 

Genetic testing for prostate cancer is also called:  

• Genetic testing for an inherited mutation

• Genetic testing for an inherited cancer risk

• Germline testing

Your provider can order genetic testing for you. You may also be able to get a free test sent to you at home through the PROMISE research study. 

Should I get genetic testing for prostate cancer?

It depends. Genetic testing isn’t typically included in prostate cancer screening, diagnosis, or treatment. But current guidelines say you should get tested if:

• You have metastatic (widespread) prostate cancer. This can either mean that you had metastatic cancer when you were first diagnosed or that your cancer spread later.

• And/or you have high-risk prostate cancer. High-risk prostate cancer means your PSA is over 20, you have grade group 4 or 5 (Gleason 8 to 10), or your cancer has spread outside of the prostate.

• And/or you have a family history of cancer. Having a “family history” means you have relatives with prostate cancer — or other cancers like breast, ovarian, pancreatic, and colon cancers. Family history is especially important if you have multiple family members with cancer, they got it at an early age, or they died from it.

Other groups of people may also benefit from testing. Talk to your doctor about whether genetic testing is right for you. It may be if:

• Your prostate biopsy shows intraductal carcinoma or cribriform pattern

• You have a relative with a known prostate cancer gene mutation (like BRCA1 or BRCA2)

• You are of Ashkenazi Jewish ancestry

How does genetic testing affect my prostate cancer treatment? 

Most of the time, you don’t need genetic testing to get started with treatment. 

But in some cases, genetic testing can help you and your doctor make the best choices — especially if your cancer hasn’t responded well to first-choice treatment. For example, people with certain mutations may be able to enroll in clinical trials or benefit from specialized medications (like rucaparib and olaparib).

What can I do to lower my chances of getting prostate cancer?

You can’t change your family history or your inherited genes. But lifestyle choices can help you keep your prostate healthy — and potentially lower your risk for prostate cancer. 

This includes:

• Eating a healthy diet full of whole grains, fruits, and vegetables

• Cutting back on red meat, processed meat, and alcohol

• Eating foods that are rich in vitamins and minerals

• Exercising

• Maintaining a healthy weight 

• Quitting smoking

• Talking to your providers about prostate cancer screening

If you do have a higher risk for prostate cancer, there are also some medications that can potentially reduce your risk. Talk to your provider about whether this approach is right for you. 

Are there other factors that increase my risk of prostate cancer?

Yes. In addition to family history and genetics, the biggest risk factors for prostate cancer are your:

• Age

• Race

• Life experiences including diet, smoking, obesity, and exercise

Read more about risk factors in our GoodRx article about the causes of prostate cancer. 

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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