A “family history” of prostate cancer simply means the disease has affected close relatives — most often a father, brother or son. Your risk also increases if several relatives are affected, if they were diagnosed at a younger age, or if there’s a pattern of related cancers in the family (such as breast or ovarian cancer) because some cases share inherited genes. It doesn’t mean you will get prostate cancer, but it does change the level of risk and when to start checking.
This guide sets out what a family history really means for you: how it alters risk, how age and ethnicity interact, which genes are involved, and who should consider genetic testing in the UK. You’ll find clear timelines on when to start PSA checks, what screening involves (PSA, DRE, MRI and biopsy), how to prepare for your GP appointment, implications for women in your family, practical lifestyle steps, symptoms to note, and where to access specialist support.
What does family history of prostate cancer mean?
Family history prostate cancer means you have close blood relatives who’ve had the disease. It usually refers to first‑degree relatives (father, brother, son), but second‑degree relatives (grandfather, uncle) also matter. Risk is higher when more than one relative is affected, when someone was diagnosed under 60, or when there’s a pattern of related cancers (notably breast or ovarian) because some cases are linked to inherited genes such as BRCA1 or BRCA2. It counts on both your mother’s and father’s sides, and it guides when to start discussing checks with your GP.
How family history changes your risk
If you have a family history of prostate cancer, your baseline risk shifts. In the UK, about 1 in 8 men are diagnosed in their lifetime. Having a father or brother with prostate cancer makes you roughly two‑and‑a‑half times more likely to develop it. Risk rises further when more relatives are affected, when diagnoses occurred under age 60, or when there’s a pattern of breast or ovarian cancer in the family because of shared genes such as BRCA. Only around 5% of cases are due to inherited syndromes, but family clustering still matters.
- First‑degree relative: about 2.5x lifetime risk.
- Multiple close relatives: risk increases further.
- Early diagnoses or BRCA2 in family: higher and often earlier risk.
If any of these apply, speak to your GP about starting checks sooner.
Age, ethnicity and other factors that interact with family history
Age is the strongest driver of prostate cancer risk. It mainly affects men over 50, with diagnoses most common between 70 and 74. Under 50, risk is low unless other factors apply. Family history prostate cancer brings checks forward, and risk rises earlier still for Black men: in the UK about 1 in 4 Black men will get prostate cancer, and they’re more likely to be diagnosed younger. If you’re Black or have a family history, speak to your GP from around 45.
Body weight also matters. Being overweight is linked with aggressive or advanced disease, so keeping a healthy weight and staying active is sensible.
- Age: risk climbs after 50; earlier discussion if higher risk.
- Ethnicity: Black men have higher, earlier risk.
- Family pattern: more relatives/younger diagnoses increase risk further.
Genes linked to hereditary prostate cancer
Only a small proportion of prostate cancers are caused by inherited gene variants, but when they are, certain genes stand out. The strongest and best‑established link is with BRCA2, which raises lifetime risk and is associated with earlier, often more aggressive, disease. BRCA1 may raise risk slightly, though evidence is less clear. Variants in DNA mismatch‑repair genes associated with Lynch syndrome can also increase prostate cancer risk, particularly when there’s a family pattern of bowel or endometrial cancer. BRCA variants are more common in people with Ashkenazi Jewish ancestry (around 1 in 40) than in the general population (around 1 in 300–400), which is why ancestry can help guide discussions about testing.
- BRCA2: higher lifetime risk; earlier and more aggressive cancers.
- BRCA1: possible slight increase; evidence mixed.
- Lynch syndrome genes: raised risk alongside colorectal/endometrial cancers.
Who should consider genetic testing and counselling in the UK
In the UK, genetic counselling and testing are considered when your personal or family history suggests an inherited risk. Your GP can take a detailed family history and, where appropriate, refer you to clinical genetics; testing ideally starts with an affected relative, in line with NICE familial breast cancer guidance.
- Early or multiple cases: Prostate cancer in a first‑degree relative under 60, or several close relatives affected.
- Breast/ovarian pattern: Families with early‑onset, bilateral, or male breast cancer.
- Known/likely BRCA: A known BRCA1/2 variant, Ashkenazi Jewish or Whalsay (Shetland) ancestry. NHS England currently offers free BRCA testing to people 18+ with at least one Jewish grandparent.
- Metastatic disease: Men with metastatic prostate cancer may be considered for germline testing.
- Possible Lynch: Prostate cancer alongside colorectal or endometrial cancers in the family.
Genetic counselling explains benefits, limits and implications for you and your relatives.
When to start checking: recommended timelines by risk group
There isn’t a one‑size‑fits‑all start age; timing depends on your personal risk. In the UK, Prostate Cancer UK advises speaking to your GP about tests from 50 if you’re concerned. If you’re higher risk because of family history prostate cancer or you’re Black, start that conversation from 45. Where several relatives are affected or diagnoses occurred under 60, be proactive at 45 and ask about genetic counselling too.
- Average risk (not Black, no family history): discuss PSA from 50.
- Raised risk (first‑degree relative with prostate cancer): discuss from 45.
- Black men (including mixed Black ethnicity): discuss from 45.
- Known/suspected BRCA or breast/ovarian cancer pattern in family: discuss from 45 and consider genetics.
Your GP will agree a plan (for example baseline PSA and follow‑up intervals) based on your risk.
Screening and early detection options (PSA, DRE, MRI and biopsy)
With a family history of prostate cancer, early detection follows a simple, stepwise pathway. Your GP will usually start with a prostate‑specific antigen (PSA) blood test and a digital rectal examination (DRE). If results suggest higher risk, you’ll be referred to a urologist for further assessment. This typically involves an MRI scan, and only if there are concerning findings would a biopsy be recommended to confirm a diagnosis. Each test has a role; together they provide clarity.
- PSA blood test: Measures a protein made by the prostate; forms the baseline and guides follow‑up.
- Digital rectal exam (DRE): A quick physical check of the prostate’s size and feel.
- Prostate MRI: Imaging that helps assess risk and decide whether a biopsy is necessary.
- Biopsy: Needle samples from the prostate examined by a pathologist; the only way to confirm cancer.
Preparing for your GP appointment
A focused GP visit saves time and yields a clear plan. Gather your family history prostate cancer details, any related cancers, your age, ethnicity and symptoms. Bring prior PSA results if you have them, and decide what you want to cover.
- Map relatives: who had cancer, relation, side, and age at diagnosis.
- Include related cancers: breast, ovarian, colorectal or endometrial in the family.
- Note ancestry: factors relevant to BRCA risk (Ashkenazi Jewish or Shetland).
- Prepare questions: start age, frequency of PSA, and genetics referral.
What this means for women in your family
Some family history prostate cancer is due to inherited genes that also affect women. BRCA2 (and sometimes BRCA1) raises breast/ovarian risk; Lynch genes link to bowel and endometrial cancer. BRCA variants are more common with Ashkenazi Jewish ancestry. Women on either side should discuss genetic counselling and screening with your GP if red flags apply.
- Known BRCA or Lynch variant.
- Prostate cancer under 60 or multiple relatives.
- Clusters of breast, ovarian, bowel or endometrial cancer.
Lifestyle and risk reduction: what you can and can’t change
You can’t change your age, genes or ethnicity, and there’s no proven way to prevent prostate cancer. But with a family history prostate cancer, focusing on what you can influence matters. Being overweight is linked with a higher chance of aggressive or advanced disease. A healthy diet and regular physical activity help you stay a healthy weight, which supports lower risk and better overall health.
- Maintain a healthy weight: prioritise steady, sustainable weight control.
- Be active most days: build in regular movement (for example, brisk walking).
- Eat sensibly: aim for balanced, varied meals to support weight management.
- Stay organised with checks: pair healthy habits with timely PSA discussions.
Signs and symptoms to take seriously
Early prostate cancer often causes no symptoms, so if you have a family history, don’t wait for warning signs—speak to your GP about checks. If you do notice changes, get them assessed promptly. Many are due to benign issues, but they can also signal prostate problems that need timely investigation.
- Changes in urinary habits: frequency, urgency, or waking at night.
- Blood in urine or semen (haematuria).
- Unexplained pain: back, bladder or testicular pain.
- Persistent infections or difficulty passing urine.
See your GP promptly if symptoms are new, persistent or worsening—especially if you’re Black or have an affected first‑degree relative.
Where to get support and specialist care
Getting the right support early matters if you have a family history of prostate cancer. Start with your GP for baseline PSA and referral. Prostate Cancer UK’s Specialist Nurses (Risk Information Service) can explain your risk and tests. If your history suggests an inherited syndrome, ask for NHS clinical genetics. For rapid specialist assessment and second opinions in London, you can book with Mr Ashwin Sridhar, Consultant Urological Surgeon.
Key takeaways and next steps
A family history of prostate cancer doesn’t mean you’ll develop it, but it does raise your risk and brings forward the conversation about checks. Risk is higher with an affected father or brother, in Black men, and when BRCA2 or certain Lynch genes run in the family. Early detection typically starts with PSA and DRE, followed by MRI and biopsy only if needed.
- Map your family history: both sides, who was affected, and ages at diagnosis.
- Time your checks: discuss PSA from 45 if higher risk or Black; from 50 otherwise.
- Ask about genetics: if multiple/early cases, breast/ovarian or bowel/endometrial cancers.
- Track results and stay healthy: keep PSA records; aim for a healthy weight and regular activity.
For a fast, personalised plan, book a consultation with Mr Ashwin Sridhar.
