Medically reviewed by Mr Maneesh Ghei, Consultant Urological Surgeon (GMC: 5208045). Last reviewed June 2026.

If your father or brother has been diagnosed with prostate cancer, one of the first questions you will ask is whether it is hereditary and whether that puts you at risk. Family history does significantly increase risk, but the picture is more nuanced than a simple yes or no. This guide explains what the genetics of prostate cancer actually look like, which genes matter, and what the increased risk means for your screening decisions in practical terms.

Is prostate cancer hereditary or just familial?

This distinction matters clinically. Hereditary means there is a specific, identifiable gene mutation being passed down, something that can be detected through genetic testing. Familial means the cancer clusters in families, but the exact genetic mechanism has not been pinpointed. Most of what we see in practice is familial rather than strictly hereditary.

Around 5-10% of prostate cancers are directly attributable to inherited high-risk gene mutations. A further 15-20% show a familial pattern: more cases in the family than would be expected by chance, likely due to a combination of lower-penetrance genetic variants and shared environmental factors, without a single causative mutation identified.

A man whose father had prostate cancer probably carries some degree of elevated genetic risk, even if BRCA testing comes back clear. That elevated risk is real and should influence when he starts PSA screening.

Which genes are linked to hereditary prostate cancer?

BRCA2: The gene most strongly associated with hereditary prostate cancer. Men with a BRCA2 mutation have approximately a 5-fold increased risk compared with the general population, and the cancers that develop tend to be more aggressive, diagnosed at younger ages, and more likely to spread. BRCA2 is the same gene strongly linked to breast and ovarian cancer in women, which is why a family history of these cancers on either your mother’s or father’s side can be relevant to your prostate cancer risk.

BRCA1: Also associated with increased prostate cancer risk, though to a lesser degree than BRCA2. The elevated risk is approximately 2-fold.

HOXB13: A gene mutation more specifically linked to prostate cancer than BRCA. Men with the G84E variant of HOXB13 have a significantly elevated risk, particularly if the cancer occurred in a young relative. HOXB13 testing is not yet standard in all genetics clinics but is increasingly available.

Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2): Lynch syndrome, most commonly known for its strong association with bowel and endometrial cancer, also increases prostate cancer risk. Men with Lynch syndrome should discuss prostate cancer surveillance with their oncologist.

ATM: ATM mutations have been associated with increased risk of prostate cancer, though evidence on penetrance is still evolving.

Carrying any of these mutations does not mean you will develop prostate cancer. It means your lifetime risk is higher than average, and more proactive surveillance is warranted.

How does family history affect your risk if no gene mutation is found?

• One first-degree relative (father or brother) with prostate cancer: risk approximately doubled
• Two or more first-degree relatives affected: risk increases 5 to 11-fold
• Relative diagnosed before age 60: greater risk elevation than if the diagnosis was in their 70s or 80s
• Multiple relatives on the same side of the family: particularly significant

A common misconception I encounter is that if genetic testing comes back negative (no BRCA mutation identified), the family history is no longer relevant. That is not correct. Genetic testing currently identifies only a minority of the inherited variants that contribute to familial prostate cancer risk. A negative genetic test does not zero out the risk conferred by a strong family history.

Should you have genetic testing?

Genetic testing for prostate cancer risk is appropriate in certain situations. Your GP or urologist may refer you to a clinical genetics service if:

• You have a known BRCA1 or BRCA2 mutation in your family
• A male first-degree relative was diagnosed with prostate cancer before age 60
• Three or more relatives on the same side of the family have been affected by prostate cancer
• Your family history includes breast, ovarian, or bowel cancer alongside prostate cancer, suggesting a shared gene fault such as BRCA or Lynch syndrome

A positive result for a known high-risk mutation tells you that your surveillance needs to be more intensive and start earlier. A negative result does not eliminate risk. It simply means the specific mutations tested for are not present. Many familial prostate cancers have no currently identifiable genetic cause. Once you start screening, our guide to whether a PSA test is reliable will help you interpret results in context.

What other risk factors contribute alongside genetics?

Age: The single largest risk factor for prostate cancer, regardless of family history. Risk rises steeply after 50 and again after 65. Most prostate cancer diagnoses occur in men over 65.

Ethnicity: Black African and Black Caribbean men have the highest incidence of prostate cancer in the UK, roughly twice the rate of white men. They also tend to be diagnosed at younger ages. Family history raises an already elevated baseline risk, making earlier screening particularly important for this group.

Diet: High consumption of red and processed meat and low vegetable intake are associated with modestly higher prostate cancer risk in population studies. No single food has a large effect on its own.

Obesity: Associated with higher-grade prostate cancer and worse treatment outcomes. Maintaining a healthy weight is beneficial across a wide range of cancer risks, including prostate.

What are the early warning signs of prostate cancer to watch for?

• Difficulty starting urination or a weak, interrupted stream
• Needing to urinate more frequently, particularly at night
• A feeling of incomplete bladder emptying
• Blood in urine or semen
• Persistent dull ache in the lower back, pelvis, or hips

If you have a family history of prostate cancer, do not wait for symptoms before seeking a PSA check. Most early prostate cancers are found through routine blood testing, not symptoms. Read our guide on how to check for prostate cancer at home for what you can monitor yourself before booking a formal assessment. You can read more about what to expect from a private prostate cancer screening at Urocare London.

Frequently Asked Questions

If my father had prostate cancer, will I get it too?

Not necessarily. Having a father with prostate cancer approximately doubles your lifetime risk, but most men with a positive family history do not develop the disease. The family history shifts your risk from the population average to a higher-than-average level, which means earlier and more regular PSA screening is appropriate.

Does it matter which relative had prostate cancer, father or brother?

Both are significant. A brother with prostate cancer carries a similar or slightly higher risk signal than a father, because a brother is the same generation and any shared genetic risk is more likely to manifest at a similar age. Multiple relatives on the same side of the family, particularly if diagnosed under 60, represent the strongest risk signal.

Can prostate cancer skip a generation?

Inherited gene mutations can be carried by individuals who never develop cancer themselves and then passed to the next generation. A genetic predisposition can appear to skip a generation. This is one reason why knowing your grandparents’ cancer history is also useful.

Should I have BRCA testing because of my family history?

If your family history includes BRCA-related cancers, particularly breast or ovarian cancer in female relatives, or early-onset prostate cancer in male relatives, it is worth discussing BRCA testing with your GP or a clinical genetics service. A positive BRCA2 result has significant implications for your prostate cancer surveillance and for other relatives who may want to be tested.

At what age should I start PSA testing if I have a family history?

Men with one first-degree relative diagnosed with prostate cancer should begin PSA discussions at 45. If multiple relatives were affected, or if one was diagnosed before 60, starting at 40 is reasonable. Black African and Caribbean men with any family history should start at 40 to 45. The frequency and intensity of surveillance thereafter depends on your initial PSA level and how it trends over time.

If I have a BRCA2 mutation, am I guaranteed to develop prostate cancer?

No. A BRCA2 mutation significantly raises your lifetime risk, from roughly 15% in the general population to an estimated 25-30% or higher, but the majority of BRCA2 carriers do not develop prostate cancer. The mutation means closer monitoring is warranted, not that cancer is inevitable.

Is genetic testing available on the NHS for prostate cancer risk?

NHS genetic testing for prostate cancer risk is available through clinical genetics services, but access depends on family history criteria. Men with a strong qualifying family history can be referred by their GP. Private testing is also available and can be arranged more quickly, though the results should still be interpreted with specialist guidance.

Can I reduce my prostate cancer risk if I have a family history?

You cannot change your genetics, but you can modify the factors that interact with them. Maintaining a healthy weight, eating a diet high in vegetables and low in processed meat, exercising regularly, and not smoking are all associated with modestly lower risk or better outcomes if cancer does develop. The most important action you can take is committing to regular PSA screening so that any cancer is caught early, when it is most treatable.

Sources

• NHS: Causes of prostate cancer
• NICE guideline NG131: Prostate cancer diagnosis and management
• BAUS: Prostate cancer patient information
• Cancer Research UK: Inherited genes and prostate cancer risk

This article is for information only and is not a substitute for personalised medical advice. If you have concerns about prostate cancer risk due to your family history, speak to your GP or a consultant urologist.

About the Author

Mr Maneesh Ghei, Consultant Urological Surgeon (GMC: 5208045)

Mr Maneesh Ghei is a consultant urological surgeon with NHS and private practice across four London hospitals. He specialises in the diagnosis and management of prostate conditions including BPH, prostatitis and prostate cancer, as well as urinary symptoms, kidney stones and male sexual health. Mr Ghei sees new patients privately with same-week availability. No GP referral is required. Book a prostate screening consultation.