My Brother Has Prostate Cancer: What Should I Do?

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Several recent studies have examined the impact of family history on the development and growth of prostate cancer. What they have found should be of concern to those with family members with prostate cancer. I'll discuss some of these findings in more detail.

Who is considered a "family member?"We're not referring to your third uncle once removed or your wife's brother. "Family members" are considered first-degree blood relatives: your father, brother or son. If many people in the family have prostate cancer, we would start looking at additional family members, including your uncles, cousins and grandfathers. However, because prostate cancer is very common in the elderly, these studies only considered family members who were diagnosed before age 65.

What did the studies show? A recent presentation at the American Urological Association national meeting looked at over 10,000 German men who had a radical prostatectomy for treatment of prostate cancer. They grouped family histories into three groups. "Sporadic" cancer occurred in men with no other family members. "Familial" cancer occurred in one or two family members, and it was considered "hereditary" cancer if three family members had it or if it occurred in three generations in a row. They found that people with hereditary prostate cancer tended to have the most aggressive disease and were more likely to die from it. Patients with familial cancer did better, and those with sporadic cancer did the best. This relationship was found in all ways of assessing prostate cancer risk. Another study, published in European Urology, had similar results. They looked only at the number of family members with prostate cancer and did not group them into categories. They found that the more family members with prostate cancer, the worse the prostate cancer was.

My brother has prostate cancer: do I? These studies should be taken with caution, as they look at overall trends. Most prostate cancer remains sporadic, meaning that it is not hereditary. Just because your father or brother has it does not mean that you will get it. Even if you do, it is not necessarily more dangerous. In fact, early detection of prostate cancer leads to a cure over 90 percent of the time. But if members of your family have prostate cancer, you should certainly be proactive about screening. We recommend annual PSA screening (a blood test) beginning at age 40 for all men with a family history. Borderline high PSA levels should also be referred to urologists, as prostate biopsies (how we actually diagnose cancer) are more often positive in men with a family history.

David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site, Robotic Oncology, has been translated into six different languages and is one of the most popular urology sites on the Internet.