Prostate cancer – the Family History Clinic

The Family History Clinic is a new service set up to provide dedicated care, advice and treatment for people with relatives diagnosed with prostate cancer, or other related cancer.

There is prostate cancer in my family. What does that mean for me?

If a first degree relative is diagnosed with prostate cancer before the age of 60, your own risk increases by about four times the average risk. A first degree relative is a father or son.

An uncle is a second degree relative and if an uncle is diagnosed with prostate cancer before the age of 60, your own risk is two times the average risk.

The age of your relative when they develop prostate cancer is very significant. By the age of 80, around half of all men have some cancer cells in their prostate, but they are usually slow growing and unlikely to cause death.

When prostate cancer develops at a younger age – in the forties and fifties – this can be a more aggressive form of the disease which is more likely to spread to other parts of the body.

Therefore, if your father is diagnosed with prostate cancer at the age of 75, it will reflect less of a family risk than if your brother is diagnosed at the age of 53.

It is also important to look at incidence. If more than one first degree relative is diagnosed with prostate cancer, your risk increases fourfold, regardless of their age when the disease develops.

There is also evidence that a faulty gene called BRCA2 linked to breast cancer, in men can increase the risk of prostate cancer fivefold.

The average lifetime risk of developing prostate cancer is one in 12.

What is known about prostate cancer and genes?

A major project called the UK Genetic Prostate Cancer Study is currently underway to identify and profile genes linked to prostate cancer.

In February 2008, researchers reported that they have identified 12 different genes which increase the risk of prostate cancer for the carrier.

This work has the potential to translate into a genetic test to show the risk each individual faces as a result of his genetic variants.

However, this work is still in development and it is likely to be many years before an effective genetic test for prostate cancer is available.

The Family History Clinic – informed care to manage risk

Family history based services and genetic counselling are rapidly developing in the NHS, for example, if there is a history of breast or colon cancer.

However, there is not currently any service designed specifically for men with a family history of prostate cancer.

We have established the Family History Clinic to provide individually-tailored, informed care for people who have prostate cancer in their family.

Consultant Urologist Alan Doherty explains: “We know that many men ask for a PSA test when their father or brother is diagnosed with prostate cancer and that unfortunately, their concerns are often dismissed as unnecessary anxiety. The Family History Clinic takes information about family history as an important resource in understanding an individual’s risk and managing their care.”

Creating a PSA surveillance system with individual record cards

We recommend that men with a family history of prostate cancer have a PSA test every one or two years.

PSA stands for Prostate Specific Antigen, a protein made by the prostate which naturally leaks into the bloodstream when the prostate is damaged.

A simple blood test can be taken to measure levels of PSA and a high reading indicates prostate cancer may be present.

We would recommend yearly tests if a relative was diagnosed with prostate cancer under the age of 60 and two yearly tests if over that age.

It is very important that a record of your PSA tests is kept, so your doctor can easily see how your PSA is behaving over several years. This provides doctors with a ‘PSA surveillance’ system – information from PSA tests is most valuable doctors can see a pattern of results.

For example, PSA levels may be within the thresholds, or recommendations, for a patient’s age, but if it has risen significantly during a single year, this would indicate further tests may be necessary.

The Birmingham Prostate Clinic provides patients with an individual PSA record card.

Nula Allen, Advanced Nurse Practitioner at the Birmingham Prostate Clinic explains: “We have a range of good, new diagnostic tools to help us better understand prostate cancer. This enables us to provide more effective, individually-tailored care for patients with a family history of prostate cancer.”

The new 10 minute PSA test reduces waiting and anxiety

We recognise people often feel very anxious waiting for their PSA results, particularly if there is a family history of prostate cancer.

Standard PSA tests are sent away to a laboratory which means patients must wait days or weeks and return for a second appointment to receive their results.

We have therefore introduced PSAWatch, a new test which provides results within ten minutes. This means you can receive your results from your consultant during a single appointment.

The Family History Clinic - services for patients