Should I get screened if I have a family history of cancer?

Question

Hello doctor,

I am 64 years old and feeling very confused after my annual checkup because my doctor mentioned cancer screening. My husband died from prostate cancer three years ago, and it was very difficult to watch him undergo radiation and hormone therapy. His prostate-specific antigen level was over 45 when it was finally detected, and by that time, the cancer had already spread to his bones.

Now I am worried because I have been experiencing urinary symptoms such as waking up five to six times at night to urinate and feeling like I cannot empty my bladder. My gynecologist performed an ultrasound and said that everything looked normal with my bladder and uterus, but the symptoms are still present.

I also have a family history of breast cancer.
My sister was diagnosed at the age of 52 and tested positive for a BRCA1 mutation.
My doctor has recommended genetic testing for me as well, as prostate cancer in the family can be associated with the same gene mutations that cause breast and ovarian cancer in women. Is this true?
Should my daughters also be concerned since their father had prostate cancer?

I need help understanding the connection between these cancers.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand how upsetting and confusing this situation is, especially after everything experienced with a spouse, and, understandably, this has triggered fear and concern. First, to gently clarify, women do not have a prostate gland, so women themselves do not develop prostate cancer. The urinary symptoms being experienced, such as frequent nighttime urination and the sensation of incomplete bladder emptying, are very common in women of this age group.

These symptoms are usually related to age-related bladder changes, pelvic floor dysfunction, overactive bladder, or hormonal changes after menopause rather than cancer, particularly since the ultrasound findings were normal. That said, the doctor is correct in noting that the family history described is important, but for genetic reasons rather than because of a personal risk of prostate cancer.

There is a real and well-established connection between certain inherited gene mutations, especially BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2), and several cancers affecting both men and women. In women, these mutations increase the risk of breast and ovarian cancer. In men, they increase the risk of prostate cancer, as well as male breast cancer and, in some cases, pancreatic cancer.

The fact that a sister developed breast cancer at a relatively young age and tested positive for a BRCA1 mutation makes genetic testing a reasonable step. This recommendation is not related to the current urinary symptoms, but rather to understanding inherited cancer risk within the family. Knowing genetic status can help guide appropriate screening for breast and ovarian cancer and allow doctors to individualize care.

Daughters should also be informed about this family history. Their father’s prostate cancer, particularly if it was aggressive and diagnosed with a high prostate-specific antigen (PSA) level, combined with a known BRCA mutation in the family, does increase the likelihood of an inherited genetic risk. This does not mean that the daughters will definitely develop cancer, but it does mean that genetic counseling and, if advised, genetic testing can be very helpful.

Such steps allow for earlier and more careful screening, which can be life-saving. Witnessing a spouse suffer through cancer treatment can be deeply traumatic, and it is natural to fear a similar experience. However, the purpose of genetic evaluation is prevention and early detection, not to suggest that the same condition is currently present. Seeking clarity and asking informed questions is the right approach, and with proper guidance, it is possible to move forward with knowledge and reassurance rather than fear.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.