Prostate cancer (PC) is an abnormal and uncontrolled growth of cells that begins in the prostate, a small gland located just below the bladder in males. The prostate’s primary function is to produce the fluid that nourishes and transports sperm in semen. About one in eight men receive a diagnosis in their lifetime, and age stands as the single most significant risk factor for its development.
Age as the Primary Driver of Prostate Cancer Risk
The risk of a prostate cancer diagnosis increases dramatically across a man’s lifespan, with the average age at diagnosis being about 67 years. Incidence rates are very low for men under age 40. The chance of a diagnosis begins to rise rapidly after age 50, which is why half of all cases occur in men aged 65 or older. This increase is partly explained by the distinction between latent and clinical prostate cancer. Latent cancer refers to small, non-aggressive tumors often found incidentally during autopsy that may never cause symptoms, while clinical cancer is aggressive, grows quickly, and requires treatment.
The vast majority of new cases (approximately 52%) are diagnosed in men between the ages of 55 and 69. Incidence rates are highest in men aged 70 or older, who account for 43% of cases. Advanced age is associated not just with a higher incidence, but also with more aggressive disease. The risk of high-risk, localized disease in men aged 75–79 is approximately six times greater than in men aged 55–59.
Non-Age Factors Influencing Prostate Cancer Incidence
While increasing age is the most powerful predictor, several other factors modify a man’s individual risk profile. Genetics and a strong family history are well-established risk modifiers. Having a father or brother with prostate cancer more than doubles a man’s risk compared to the general population, and the risk is even higher if the relative was diagnosed at a younger age.
Specific inherited gene mutations, such as those in the BRCA1 and BRCA2 genes, are linked to a higher lifetime risk of prostate cancer. Men who inherit these genetic changes, particularly in BRCA2, often develop the disease earlier in life and may present with more aggressive forms. Hereditary factors account for a significant portion of the variability in prostate cancer risk, estimated to be as high as 57%.
Racial and ethnic background also plays a substantial role in incidence and mortality rates. African American men have a markedly higher risk of developing prostate cancer, with an incidence rate approximately 75% higher than in non-Hispanic White men. They are also more likely to be diagnosed at a younger age and with more aggressive cancers. Conversely, men of Asian American, Hispanic, and Latino descent tend to have lower incidence rates compared to non-Hispanic White men.
Age-Specific Screening Recommendations
Age-based recommendations for screening typically involve the Prostate-Specific Antigen (PSA) blood test and sometimes a Digital Rectal Exam (DRE). The PSA test measures a protein produced by the prostate gland, and its level can be elevated in the presence of cancer or other benign conditions. A DRE is a physical examination where a clinician feels the prostate through the rectal wall to detect any lumps or abnormalities.
For men at average risk, screening discussions should begin around age 50, provided they have a life expectancy of at least ten more years. The process should always involve shared decision-making, where a man weighs the potential benefits of early detection against the potential harms of overdiagnosis and unnecessary treatment. If a man chooses to be tested, the frequency of screening is often determined by the initial PSA result; men with a low PSA (such as below 2.5 ng/mL) may only need retesting every two years.
For men considered to be at high risk, screening should start earlier to account for their elevated and earlier incidence rates. This high-risk group includes African American men, as well as men who have a first-degree relative diagnosed with prostate cancer before the age of 65. For these individuals, screening discussions should begin around age 45. Men with a very strong family history, such as multiple first-degree relatives diagnosed at an early age, may be advised to begin the conversation as early as age 40.
Screening guidelines generally recommend stopping testing in the mid-70s. Because prostate cancer is often slow-growing, screening is not recommended for men with a limited life expectancy, as the harms of detection outweigh the benefit. For men over age 75 who are in very good health, the decision to continue screening should be made individually, based on their overall health status and previous test results.