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Last updated August 7, 2019. 6 minute read

Prostate cancer risk factors: what you can and can't change

The three most important risk factors for prostate cancer are age, family history, and African American heritage. The level of saturated fat in your diet may affect your risk of developing prostate cancer as well as how often you ejaculate, your BMI, and whether or not you’re a smoker.

Dr Tzvi Doron Do Written by Dr. Tzvi Doron, DO
Reviewed by Dr. Mike Bohl, MD, MPH

Prostate cancer is one of the most feared cancers by men and with good reason. Not only is it the most common cancer in men (CDC, 2019) aside from skin cancer, but also the second most common cause of cancer death in men (CDC, 2019). Much of the fear around prostate cancer is related to misinformation and fear of side effects of treatment. The good news is that most men who are diagnosed with prostate cancer will not die from the disease. What’s more,  side effects due to treatment are less common and more easily treated than in the past. Learning about risk factors helps men make informed decisions about lifestyle choices and screening.

Vitals

  • The three most important risk factors for prostate cancer are age, family history, and African American heritage.
  • The level of saturated fat in your diet may affect your risk of developing prostate cancer as well as how often you ejaculate, your BMI, and whether or not you’re a smoker.
  • Knowing your risk for prostate cancer can help guide lifestyle choices and decisions about screening.

Clear risk factors for prostate cancer

The three most important risk factors for prostate cancer are age, family history, and African American heritage. Age is a risk factor for many diseases, prostate cancer being one of them. This is because we build up genetic mutations over time,  increasing the odds of developing cancer.

African American men have higher risks of getting prostate cancer, dying from prostate cancer, and getting the disease at a younger age. Exactly why is unknown, though it may be due to genetic factors, environmental factors (diet and exercise habits), socioeconomic factors, limited access to healthcare, or some combination of these things. 

Family history determines inherited genes that predispose men to develop prostate cancer, but the precise genes involved are usually not known. Some exceptions include mutations in the BRCA1 and BRCA2 genes. 

Though most commonly associated with increased risk of breast and ovarian cancers in women (these mutations are called hereditary breast and ovarian cancer syndrome), BRCA1 and BRCA2 in men increase the risks of certain cancers, including prostate cancer. Men with BRCA1 mutations have 3.5 times the risk of developing prostate cancer, and those with BRCA2 mutations have 8.6 times the risk (Castro, 2012). Also, men who are BRCA1 or BRCA2 positive tend to get more aggressive cancers than men who are negative, and they are more likely to die of prostate cancer.

Another inherited mutation associated with an increased risk of prostate cancer is the HOXB13 gene (Ewing, 2012).  his gene variant is more common in those with early-onset, familial prostate cancer.  However, how exactly this gene plays a role in the development of prostate cancer is currently unknown.

Certain chemical exposures may increase the risk of prostate cancer. Agent Orange is one such chemical. One study (Ansbaugh, 2013) showed that veterans exposed to agent orange had a higher risk of prostate cancer, which was driven by a higher risk of more aggressive tumors.

Less clear risk factors for prostate cancer

The risk of prostate cancer varies widely by geography. Rates of prostate cancer in the West are much higher than they are in China and Japan. For example, one study (Shimizu, 1991) showed that Japanese men living in Japan had much lower rates of prostate cancer. It was found, however, that those rates increased when they moved to the United States regardless of their age when they immigrated. This research suggests that there may be some lifestyle factors contributing to the increased prostate cancer risk in the West, including diet. People who eat a lot of red meat and saturated fat intake have a greater risk of developing prostate cancer than those who eat less.

In some early studies, men who had had a vasectomy had a higher risk of prostate cancer. However, other research (Holt, 2008) did not show this increased risk, and having a vasectomy is not considered a clear risk factor for prostate cancer.

Sexually transmitted infections (STIs) are also not a clear risk factor for prostate cancer, although some studies did show that men with a history of gonorrhea, syphilis, and certain types of HPV had an increased risk for prostate cancer. 

Smoking is a risk factor for many cancers, including cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia. Some research (Cerhan, 1997) shows that smokers have an increased risk of prostate cancer, while one study (Giovannucci, 1999) showed no increased risk of developing prostate cancer in smokers although smokers did have a higher risk of dying from prostate cancer than non-smokers. 

Another study (Kenfield, 2011) similarly found that being an active smoker at the time of prostate cancer diagnosis is associated with increased mortality (death) and the chances of the cancer returning.

Obesity (Parikesit, 2016) is a risk factor for prostate cancer in general as well as more aggressive prostate cancer, but it is not as strong a risk factor as family history or having African American heritage.  Obesity is defined as having a body mass index (BMI) greater than 30. You can find out your BMI by multiplying your weight in pounds by 703 then dividing the result by your height in inches squared. 

703 x weight (lbs) / [height (in)]2 

One review (Campos, 2018) points out that physical activity can be protective against prostate cancer development and that exercise can lead to better outcomes in those who are being treated.

Ejaculatory frequency may be a negative risk factor for prostate cancer,  meaning that ejaculating more frequently can reduce risk. A 2016 study (Rider, 2016) showed that men who ejaculated at least 21 times per month had a lower risk of prostate cancer than those who ejaculated 4–7 times per month. We can’t say for sure if ejaculating more frequently will lower your risk of prostate cancer, but there’s a chance that it might, and there are no known harms.

Prostate cancer: know your risk

Knowledge is power, and knowing your risk for prostate cancer can help guide lifestyle choices and decisions about screening. For example, men with a strong family history, African American men, and men with inherited BRCA1, BRCA2, or HOXB13 mutations may decide to get screened earlier, more frequently, and may choose to cut meat and dairy from their diet to lower their risk.

It’s a good idea to avoid smoking and risky sexual behavior that may lead to acquiring an STI, but knowing their prostate cancer risk may motivate men to make healthier lifestyle choices. Discuss your risk factors with a healthcare professional and how they affect your decision to screen for prostate cancer.