A prostate cancer diagnosis can bring up questions that go beyond treatment – why it happened, whether it runs in the family, and what it could mean for your children or siblings.
Prostate cancer genetics is a fast-moving part of modern care. In the right setting, it can help clarify inherited risk, inform screening decisions, and sometimes guide personalised treatment.
In this article, we explain what people mean when they ask if prostate cancer is genetic, the difference between germline prostate cancer and prostate cancer genomic testing, and who may want to discuss one (or both) with a specialist.
Is prostate cancer genetic?
Is prostate cancer genetic? For many men, the most accurate answer is “partly”. Most prostate cancers are not caused by one inherited gene change. Risk usually reflects a combination of age, hormones, environment and genetics.
So, is prostate cancer genetically inherited? Sometimes. A family history increases risk, especially when prostate cancer appears in several close relatives, when diagnoses happen younger than expected, or when there’s a pattern of related cancers in the family (for example, breast, ovarian, pancreatic or bowel cancer).
Certain inherited mutations can raise risk more significantly, including BRCA2 (and BRCA1), as well as genes such as HOXB13 and DNA repair genes like ATM and CHEK2.
If you’re thinking about screening because of family history, this is a useful starting point.
What is germline testing in prostate cancer?
Germline testing looks at the DNA you were born with – typically through a blood or saliva sample. It’s designed to identify inherited mutations that can increase the risk of prostate cancer and, in some cases, other cancers.
This matters because germline results can help answer:
- Is there an inherited reason this cancer developed?
- Could relatives have an increased risk?
- Should family members consider earlier or more structured screening?
Who may benefit from germline testing?
A specialist may suggest germline testing for prostate cancer when there’s a strong family history, early-onset disease, aggressive or high-risk features, metastatic disease, a known hereditary mutation in the family, or certain ancestry backgrounds where specific mutations are more common.
If a germline mutation is found, it does not mean relatives will definitely develop cancer. It means risk may be higher than average, so family members can make informed decisions about surveillance and screening.
What is genomic testing?
Prostate cancer genomic testing looks at the tumour itself (sometimes called somatic testing). It analyses DNA changes within the cancer cells – changes that are not necessarily inherited.
Genomic testing may help with questions like:
- How likely is this cancer to behave aggressively?
- Is active surveillance or active treatment more appropriate?
- Are there tumour features that suggest benefit from specific therapies?
In practical terms, genomic testing can include gene expression “classifier” tests performed on biopsy tissue, or tumour sequencing panels that look for actionable changes (particularly in more advanced disease). These results sit alongside PSA trends, MRI findings, biopsy grade (Gleason) and clinical staging – they don’t replace them.
Germline vs genomic testing: the simple difference
- Germline testing looks at inherited DNA (from birth). It can clarify inherited risk and has implications for relatives.
- Genomic (tumour) testing looks at DNA changes in the cancer. It can add detail about tumour behaviour and treatment options.
Sometimes both are recommended. For example, a tumour test may find a change that could be inherited, which then leads to germline testing to confirm whether it’s present throughout the body.
Who should consider which test?
This depends on your diagnosis, your family history, and what decisions you’re trying to make.
You may want to ask about germline testing for prostate cancer if you have a strong family history, relatives with related cancers (especially at younger ages), early-onset disease, aggressive or metastatic prostate cancer, or a known mutation in the family.
You may want to ask about prostate cancer genomic testing if you’re weighing active surveillance versus active treatment, your risk category feels borderline, you have locally advanced disease where treatment choices can vary, or you have metastatic disease where targeted therapies or clinical trial options are being considered.
If you’d like to explore what testing might mean in your situation, an initial specialist conversation can help.
How results can influence treatment decisions
Testing can change what “best next step” looks like. Depending on the setting, results may influence:
- Surveillance vs treatment: genomic results can sometimes add confidence when deciding whether a low-risk cancer is likely to remain slow-growing.
- Treatment planning: some tumour changes suggest a higher or lower risk of progression, which can affect treatment intensity or follow-up.
- Targeted therapies in advanced disease: certain tumour or germline findings in DNA repair pathways can help identify whether targeted treatments (such as PARP inhibitors) may be appropriate.
- Screening strategy for relatives: if a germline mutation is found, family members may choose earlier conversations about screening and tailored monitoring.
It’s worth keeping expectations realistic: testing is one input, not the whole answer. The most useful decisions still come from combining results with imaging, pathology, PSA behaviour, overall health, and your priorities.
Common questions about genetic testing
Will testing affect my insurance or employment?
It’s sensible to ask. In the UK, there is an agreement (supported by the government and the Association of British Insurers) about how predictive genetic test results can be used for insurance. Rules can change, and there may be exceptions, so it’s worth checking the latest guidance and discussing concerns with your clinician or genetic counsellor.
Employers should not pressure you to have genetic testing or to disclose results. If privacy is a concern, ask who will receive your results and how your information is stored.
What does a positive result mean?
A positive germline result means an inherited mutation has been found that can increase risk – it does not predict certainty. A positive tumour result may suggest a cancer is more likely to behave aggressively, or it may identify an actionable change. Either way, it needs to be interpreted in context.
Does a negative result guarantee anything?
No. A negative germline test does not remove prostate cancer risk, and a negative genomic result does not guarantee a tumour will not progress. These tests can reduce uncertainty, but they can’t eliminate it.
Key takeaways
- Prostate cancer genetics can inform risk assessment, screening discussions and, in some cases, treatment planning.
- Is prostate cancer genetic? Often partly – and in some families, inherited mutations play a stronger role.
- Germline testing for prostate cancer looks at inherited DNA and can inform family risk.
- Prostate cancer genomic testing looks at tumour DNA and can support decisions about surveillance, treatment intensity and targeted therapies.
If you’d like to discuss screening, diagnosis, or treatment planning and whether genetic or genomic testing could be useful for you, please reach out to us.
