Prostate problems are very common, particularly among older men. But can they affect younger men as well? Is it something that can run in the family? And how would you know if there was something wrong? Here to answer our questions is Marc Laniado , a highly-experienced prostate cancer specialist working in Harley Street, London.
How common are prostate problems?
Prostate problems are common: if you are white, you have about one in 8 chance of getting prostate cancer and about the same number may have urinary problems from an enlarged prostate . Many men will have both issues. Overall about one in 24 white men will die from prostate cancer.
Age is the most significant risk factor for being diagnosed with prostate cancer. In the UK, the average age of diagnosis of prostate cancer is about 72, but you could be diagnosed from the age of 45 upwards if you have more risk than most. Black men are more likely to get (ie one in 4) or die (one in 12) from prostate cancer. Conversely, if you have an Asian ethnic background, you are less likely to suffer from prostate cancer.
You are more likely to be diagnosed with prostate cancer if your father, brother, or son, i.e. a first-degree relative, has it. Men with two or three affected first-degree relatives had a 5 to 11 times greater risk of prostate cancer, and the earlier they had it, the higher the risk.
Other risk factors for prostate enlargement and cancer include:
- being overweight
- eating a diet that promotes inflammation (i.e. red meat, saturated fat)
- lack of exercise
- smoking has been associated with a higher chance of dying from prostate cancer.
Can prostate problems affect younger men?
The answer is yes, but prostate cancer almost always occurs in men more than age 40. Prostate problems due to prostate enlargement or cancer often run in families and occur at a younger age than those without a family history. So, if you have a first-degree relative that needed treatment, it is much more likely that you will get a prostate problem too.
In fact, about 5 to 10% of all cancers develop because a man inherits a faulty gene that encourages the disease to grow. If you have a relative with a mutation in what is known as a cancer susceptibility gene, then you should consider getting specific advice on testing for that abnormality.
Your parents can pass on genes that make prostate cancer more likely. Specifically, the BRCA and HOXB13 genes can cause problems. The BRCA genes result in a more aggressive form of prostate cancer that needs comprehensive treatment.
Hereditary prostate cancer is more likely if you have:
- two or more relatives with prostate cancer on the same side of the family
- a first-degree relative who died of prostate cancer aged less than 60 years or was diagnosed with prostate cancer aged 55 years or less
Some men have a family history suggestive of the hereditary breast and ovarian cancer syndrome (BRCA). You might be at risk if you have a relative who:
- who died from prostate cancer aged 60 or less or who has metastatic prostate cancer (ie prostate cancer that has spread)
- who has high-grade prostate cancer and another family member with any of the following:
- an instance of breast cancer less than 50 years old
- a history of ovarian or pancreatic cancer (at any age)
How do I know if there is something wrong with my prostate?
If you have early prostate enlargement or cancer, usually you have no symptoms. If the prostate enlarges from benign overgrowth (BPH), you may get symptoms as the enlarging prostate squeezes the water pipe ("urethra"). As the urinary stream gets weaker, you may have to pass urine more often than before, as the bladder muscles contract more unpredictably. Often, these changes occur very slowly, and it is only by thinking back to your 20s that you may realise that there may have been some significant changes.
In contrast, if you have early and usually curable prostate cancer, you have no symptoms as a result of cancer. You start noticing symptoms only when cancer has become large. This is often late and when the tumour is quite extensive, making it less curable by simple treatments.
You should think about seeing a health professional If you are bothered by the following:
- needing to urinate more often during the day and at night
- an urgent feeling to pass urine and leaking before reaching the toilet
- standing for a prolonged period before urine begins to pass
- straining or taking a long while while urinating with a weak or slow flow
- the feeling that your bladder has not emptied fully after going to the toilet
Please remember these symptoms do not necessarily mean you have cancer , as you may also get these symptoms when your prostate enlarges without cancer. If you have these symptoms, your doctor may have a prostate examination with a finger, blood test (PSA) and an enhanced MRI known as multiparametric MRI.
Sometimes, you may also get the following symptoms with prostate cancer:
- pain passing urine
- pain on ejaculating
- blood in the urine or semen
- difficulty with erections
When prostate cancer spreads away from the prostate, you may:
- lose weight unintentionally
- get new and persistent aches and pains in the back, pelvis or hips, or
- notice that one or both of your legs have begun to swell.
These symptoms are particularly worrying, and the doctor should evaluate them, as there may be an important and treatable reason.
If you have any of the symptoms described above, and want to be evaluated further, you need to see your doctor to have a blood test (PSA) and sometimes a multiparametric MRI. Some doctors do a urine test known as SelectMDx , which has only become available privately. It is not a replacement for the other tests but may help to decide if you are likely to have serious prostate cancer.