More than 230,000 American men will be diagnosed with prostate cancer this year and more than 30,000 will die of the disease. (1) Prostate cancer is the leading source of new cancer cases among men in the United States and the second leading source of cancer-related deaths. (1) One of the most important risk factors for the disease is having a family history of prostate cancer, with an estimated 5-10% of cases resulting from inherited factors. (1-3) Men with a father or brother with prostate cancer have more than twice the age-adjusted risk for the disease, compared with men without such family histories.

Therefore, it is not surprising that having a family history of prostate cancer has been linked to increased worry about the disease. (2) Worry about prostate cancer has been shown to be related to emotional (eg, depressive symptoms, anxiety, intrusions, and avoidance of prostate cancer-related material), (2) behavioral (eg, prostate cancer screening), (5,6) and physical (eg, abnormal prostate-specific antigen [PSA] levels) (7) outcomes. Therefore, a better understanding of the predictors of prostate cancer-related worry may help researchers to develop interventions to ameliorate these outcomes.

In addition to being related to increased worry about prostate cancer, a family history of the disease has also been found to be related to individuals’ perceived risk of prostate cancer. (8) Although there are few studies about this, those in which researchers have examined this relationship fall into one of two categories–those focused solely on men with family histories of prostate cancer (FHP+ men) and those comparing men with and without family histories of prostate cancer (FHP+ vs. FHP- men). Results of studies in which researchers focused solely on FHP+ men have generally indicated that these men have high levels of perceived risk. (2,9) The majority of researchers who have compared specifically recruited samples of FHP+ and FHP- men have also reported a relationship between family history status and perceived risk of prostate cancer. (10,11) Nevertheless, with a sample recruited from the public area of a major medical center assessed anonymously, researchers found no relationship between family history and perceived risk for prostate cancer. (12,13) Note, however, that the size of the FHP+ group in that study was small, and therefore negative findings should be interpreted with caution.

Researchers in several studies have found that men’s perceived risk of prostate cancer is related to their worrying about prostate cancer. (2,7) For example, Cohen and colleagues (7) found a positive relationship between perceived risk of prostate cancer and level of prostate cancer-related worry. In addition, among FHP+ men, increased perceived risk of prostate cancer has been related to increased likelihood of cancer worries affecting everyday life. (2)

Although the evidence strongly suggests a positive relationship between perceived risk of–and worry about–prostate cancer, the causal direction of this relationship has yet to be established. On the one hand, researchers have suggested that the cognitive perception of one’s risk for cancer engenders worry, (14) and this directionality has been supported by statistical analyses in the context of other diseases. (12) Yet, theoretical perspectives and empirical evidence in the literature has also supported the reverse causal direction. (15) That is, researchers have suggested that increased levels of worry might lead to increases in perceived risk. For example, Lerner and colleagues (16) studied a sample of Americans following September 11, 2001, and found evidence that increased levels of anxiety shortly after September 11 predicted greater risk estimates 6 to 10 weeks later. Therefore, we designed the present study to provide a test of directionality between perceived risk of and worry about prostate cancer using structural equation modeling.

Prostate cancer-specific risk and worry do not exist in isolation. Rather, they exist in the broader context of concerns about disease in general. DiLorenzo et al. (12) recently published the first study, to our knowledge, examining the interrelationships among disease-specific and more general risk and worry. Using SEM, those authors found that in the cases of breast cancer, colon cancer, heart disease, and diabetes, both family history of a specific disease and higher perceived risk of other diseases predicted heightened disease-specific perceived risk. In turn, they found that higher disease-specific perceived risk was related to higher disease-specific worry and to less worry about other diseases, and disease-specific worry in turn was related to increased worry about other diseases. In addition, higher perceived risk of other diseases was related to heightened worry about other diseases.

DiLorenzo et al.’s (12) findings are largely congruent with previous findings in the literature. For example, their finding that perceived risk of other diseases predicted disease-specific perceived risk is consistent with a recent study by McGregor and colleagues, (17) in which the authors found that generalized expectancy for risk was related to specific expectancy for risk (ie, perceived risk of breast cancer). DiLorenzo et al.’s finding of a positive relationship between perceived risk of other diseases and disease-specific worry is similarly consistent with McGregor and colleagues’ (17) finding that generalized risk expectancies were related to breast cancer worry.