Who is most at risk of getting prostate cancer?

We asked leading prostate specialist Christopher Eden, a consultant urologist at the Royal Surrey County Hospital in Guildford, to assess a group of men for their risk of developing the disease – and to offer advice on what they could do to protect themselves.

Lee Well, 52, a fireman, lives in Birmingham with his wife Lorraine, 51, a nurse and their four children, aged 22 to 30.

Six years ago, my older brother Martin was diagnosed with prostate cancer aged 53.
It was a real shock – he was fit, well, and went to the gym regularly. We had two uncles who’d been diagnosed in their 60s, but I never thought it was something that would affect my immediate family.
My brother had to have his prostate and surrounding tissues removed, as well as radiotherapy, which triggered some pretty unpleasant side-effects such as pain and erectile dysfunction.
It was awful to watch him suffer this way, but he’s now in remission.
But it’s made me mindful of any changes which could be a symptom. And I now have an annual PSA test – a blood test which checks levels of prostate-specific antigen, a protein produced normally by prostate cells, but high levels could mean cancer. My reading was 1.03, which is normal for my age.

And I had an MRI scan last year because of my family history. Thank God, everything has been clear.

In my job we’re warned about the risk of testicular cancer since chemicals found in fires can be absorbed by the skin and possibly trigger it.
So I’m fairly careful about regular self-examination. I also try to keep fit by cycling to and from work and I’ve been doing Pilates for a few years. I’m only a social drinker, maybe a couple of units a week, and am not overweight.
EXPERT VERDICT: Although Lee is fit and well (exercise boosts the immune system’s reaction to cancer), he has a first-degree relative with prostate cancer, making him two to three times more likely to get it.
Risk generally increases from the age of 45, climbing steeply from 60 – the cell mutations that lead to cancer can happen all the time, but the longer you live the more mutations you’ve had, and the greater the chance the immune system will be defeated.
This is why most cancers become more common with age. Working as a fireman may have an impact for testicular cancer, but this cancer is not linked to the prostate.
Because of his family history it’s important for Lee to keep up the PSA tests – in some countries, all men aged over 50 are recommended an annual test.
It doesn’t need to be more frequent as most prostate cancers are slow growing. In the UK, it’s up to an individual to request one, or it’s at the behest of their GP because of family history, although I think all men should have it done.
My view is that it’s vital to anticipate prostate cancer with this test as by the time symptoms show, the cancer is likely to be incurable (although not necessarily life-threatening).
In 20 per cent of cases, PSA results are inaccurate, so for Lee in particular, it’s important to combine the test with a rectal examination, which studies show improves the detection rate. Some cancers are diagnosed solely on the rectal examination.
RISK: 1 in 4

David Bor, 52, an actuary, lives in Manchester with his wife Natalie, 49, an administrator. They have five children, aged between 14 and 25.
My work is highly specialised – I assess how divorcing couples split their pension arrangements – so when I’m sitting at my desk, I simply don’t move for hours as I work out the minutiae of the case.
But then I can’t wait to start exercising. I cycle more than 100 miles a week and swim three times a week, doing up to 100 lengths at a time.
I’m 5ft 8in and weigh only just under 10st. Yet during a yearly medical, arranged through work, I was told my cholesterol was a little high – around 6 (normal is below 5.2). 
I’ve been told to try to control it through diet – avoiding fatty foods such as chocolate and cake, which I admit are my weaknesses since I don’t drink or smoke.
Overall, my health has been pretty good – in fact the main problems I have are with the injuries I sustain during exercise.
EXPERT VERDICT: David is clearly in superb shape. But if he decides to have a PSA test he should be aware cycling can temporarily inflate the readings: the constant vibrations against the hard bicycle seat can damage the tissue, injuring the prostate.
This doesn’t increase his risk of prostate cancer, but higher readings mean David might face needless invasive tests such as a biopsy (which can cause pain and bleeding).
Cycling can raise PSA for up to 48 hours so he should skip the rides for a couple of days beforehand.
The same goes for sex – ejaculation can cause PSA levels to rise temporarily for at least 24 hours.
As for his sedentary work life, a Swedish study found that men who spent most of their working lives sitting down are almost 30 per cent more likely to be diagnosed with the disease than those with very active jobs.
However David makes up for this with all his exercise.
He is also very slim, which will give him greater protection. Although his cholesterol is slightly high it doesn’t actually impact on prostate cancer.
RISK: 1 in 15
BATTLING WITH HIS WEIGHT