Dear Dr G,

I understand you usually address sexual health issues. My concerns, however, are not strictly sexual, though I worry that the consequences of this disease may affect my sexual health.

I am in my early 40s and have been sexually active throughout my life. A decade ago, my father was diagnosed with prostate cancer, and his treatment has left me fearful, especially regarding my own sexual health.

I accompanied my father to most of his treatments. He was catheterised and later underwent radiotherapy. Although he is now in remission, I learned from consultations with the urologist that he has sacrificed much in terms of sexual function and continence.

I am unsure whether there is a prostate cancer awareness month, but I hope to put Dr G on the spot regarding hereditary prostate cancer.

Can prostate cancer be inherited? Which genes are usually involved? What proportion of men have hereditary prostate cancer? Are there lifestyle changes that can help reduce the risk? Can medication or supplements prevent prostate cancer, and are there any side effects? Finally, should I inform my teenage sons that prostate cancer may run in the family?

Yours sincerely,

Hereditary Harry

September is prostate cancer awareness month, following the success of Pink Oct for breast cancer. Prostate cancer is among the most common malignancies affecting men worldwide. While most cases are sporadic, about 10–15% are hereditary, meaning they are linked to inherited gene mutations.

Understanding risk factors, recognising the genetic basis, and adopting preventive strategies are crucial for men with a family history of prostate cancer.

The genetic risk factors for hereditary prostate cancer are not yet fully understood. Key inherited mutations, such as BRCA1 and BRCA2, increase the risk of developing prostate cancer by 2–5 times, often leading to earlier onset and more aggressive disease. Other mutations, such as HOXB13, are also strongly linked to early-onset hereditary prostate cancer. Defects in DNA repair mechanisms allow mutations to accumulate, increasing susceptibility.

Having a first-degree relative (father, brother, or son) with prostate cancer doubles a man’s risk. The risk rises further with multiple affected relatives or early-onset cases in the family. Genetic counselling and testing are therefore recommended for men with several family members affected by prostate, breast, ovarian, or pancreatic cancer, or with early-onset cases (diagnosed before age 55). Known family mutations, such as BRCA1/2, or aggressive or metastatic prostate cancer are also important reasons for screening.

Genetic testing not only clarifies risk but also guides screening strategies and informs relatives about their own health. While genetic risk cannot be eliminated, lifestyle and medical strategies can help reduce the chance of developing aggressive disease.

Screening and early detection are widely recognised to save lives. PSA testing and digital rectal examination (DRE) should start as early as 40–45 years in high-risk men. More frequent monitoring helps detect cancer at an early stage, increasing the chance of successful treatment.

Dietary approaches are important for prevention. Plant-rich diets—especially those high in fruits, vegetables, whole grains and legumes—are key. Lycopene-rich foods, such as tomatoes, and cruciferous vegetables like broccoli and cauliflower, are protective. Healthy fats, especially omega-3 fatty acids from fish, nuts, and seeds, as well as green tea and soy, contain bioactive compounds with potential benefits. Conversely, red and processed meats are linked to an increased risk of many cancers.

Lifestyle measures are also vital. Maintaining a healthy weight is important, as obesity is linked to more aggressive prostate cancer. Regular physical activity reduces inflammation and supports hormone balance. Smoking and excessive alcohol use are associated with higher cancer risk and mortality. Chronic stress and poor sleep can disrupt hormone regulation and weaken immune protection, significantly raising cancer risk.

Chemoprevention—using medicine to prevent cancer—has been widely studied in prostate cancer. Medicines such as 5-alpha-reductase inhibitors (finasteride and dutasteride) may help reduce risk, but studies show they mainly protect against lower- and intermediate-risk cancers and may actually increase the risk of aggressive cancers. These medicines can also reduce sexual libido. The role of chemoprevention remains debated, but future trials may help men with hereditary risk qualify for targeted preventive strategies.

Hereditary cancer risk affects the whole family. Genetic testing can reveal risks for siblings, sons, and daughters. Family communication is essential, empowering relatives to make informed health decisions. Psychological support and counselling are often necessary to help cope with anxiety and lifestyle changes.

Hereditary prostate cancer highlights the intersection of genetics and lifestyle. While genes such as BRCA2 and HOXB13 significantly increase risk, proactive strategies—genetic testing, vigilant screening, healthy lifestyle choices, and preventive interventions—can reduce the burden of disease.