Epidemiology of Prostate Cancer

The epidemiology of prostate cancer has provided a number of clues to the etiology of the disease. The incidence of prostate cancer increases with age. However, there is a discrepancy between the clinical incidence of prostate cancer and prevalence of the disease at autopsy [4]. The frequency of autopsy-detected cancer has been reported to be 30% to 40% in men over the age of 50. The incidence also varies markedly throughout the world, with the United States, Canada, Sweden, Australia, and France having the highest rates and Asian populations the lowest [5]. These differences may be due to genetic factors, but environmental factors may also be at play. Japanese male immigrants in the United States have a higher mortality rate compared with those in Japan [6]; dietary changes are thought to be a significant environmental factor [4,7] (Table 1.1).

Prostate cancer risk, particularly that of early-onset disease, is affected by family history. The association, however, is not as marked as in breast and colon cancer. The relative risk of prostate cancer increases markedly when the age of the index case decreases and when the number of affected family members increases

[8]. The importance of an inherited predisposition is also supported by the finding that monozygotic twins have a fourfold increased concordance of prostate cancer compared with dizygotic twins [8]. Epidemiological studies suggest that dominantly inherited susceptibility genes with high penetrance account for only 5% to 10% of all prostate cases but as many as 30% to 40% of cases with early-onset disease

Urological Cancers: Science and Treatment

Table 1.1. Proposed risk factors for prostate cancer

Possible/likely risk factors

Race

Premalignant lesions (prostatic intraepithelial neoplasia) Affected relatives Carnivorous diet Dietary fat Vitamin D Sexual habits

Controversial/disproved risk factors Benign prostatic hypertrophy Sexually transmitted diseases Cigarette smoking Alcohol intake Cadmium exposure

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