Epidemiology of Prostate Cancer
Epidemiology of Prostate Cancer
US Oncology Review 2005
Published: October 2008
Published: October 2008
Abstract
Prostate cancer is a common condition worldwide. Different geographical regions have varying incidence and mortality. Globally, prostate cancer is the sixth most common cancer, and the third most common cancer in men in developed countries.The risk of prostate cancer is increased by African-American ethnicity, increasing age, positive family history, and other factors such as diet. Nonetheless, the causes of prostate cancer are not well understood compared with other common cancers like lung and breast cancer.
The introduction of prostate-specific antigen (PSA) screening made an enormous impact on the incidence of prostate cancer, which increased in the early 1990s and is currently down to pre-PSA screening levels. Screening has caused a change in pattern of disease to an earlier stage but not lower grade. Death rates due to prostate cancer diminished in the 1990s due to a decrease in advanced cases with distant metastasis.
Introduction
About 9.7% of cancers in men are due to prostate cancer; in developed parts of world it increases to 15.3% and in the underdeveloped world it only accounts for 4.3%.1 In the US, the most commonly diagnosed cancer in men is prostate cancer and it is the second most common cause of death after lung cancer. The American Cancer Society estimates that by the end of 2004, about 230,110 new cases of prostate cancer will be diagnosed in the US. One in six men will be diagnosed with prostate cancer, and one in 32 will die of prostate cancer. It is estimated that 29,900 men in the US will die secondary to prostate cancer in 2004.2 Incidence of prostate cancer is highest in the US, Canada, and Scandinivia, and lowest in China and Asian countries.3 This variation could be due to different genetic predisposition, differences in diet, variation in quality of healthcare, and deficiencies in cancer registration; or it could be due to multiple factors mentioned above. Prostate cancer is a disease related to older age as it is very infrequent below the age of 40 but very common above 65. It is estimated that by 2030, with an increase in the proportion of people over 65 to from 12.4% 19.6%, the number of prostate cancer cases will quadruple.4 Funding for prostate cancer has increased in recent times and hopefully this will shed more light on its causes and help to devise prevention strategies.
Predisposing Factors
Age
Aging increases the risk of prostate cancer. Under 40 years old, prostate cancer is rare but over 65 years of age it is very common, accounting for 70% of cases in US.5 The lifetime risk of being afflicted with prostate cancer is 1:6. The possibility of having prostate cancer varies with age, being 13.7% for the age group 60–79 years, 2.2% for those aged 40–59, and 0.005% in those younger than 39 years. The probability of finding prostate cancer when performing autopsies in deceased people is much higher, at about 20% in men between the ages of 50 and 60 years and increasing to 50% in men between 70 and 80.The risk of having pathological evidence of prostate cancer in a 50-year-old man is 42%, the risk of it clinically becoming manifest is 9.5%, and risk of mortality is 2.9%, indicating a high degree of prevalence of sub-clinical disease.7
Race
Asians have the lowest incidence rates of prostate cancer at about 107.2 per 100,000, Hispanics have a slightly higher rate at 127.6 per 100,000,Whites have a rate of 172.9 per 100,000, and African-Americans have the highest rates of 275.3 per 100,000 – about 60% higher than Whites.The death rates also vary between different races, with data from 1992–1999 showing that African- Americans have a ratw five times higher than Asians, three times higher than that of Hispanics, and twice that of Whites.African-Americans are more likely to present with advanced disease than Whites as per results from the Surveilance, Epidemiology and End Result (SEER) program of the National Cancer Institute, but there is no difference in grade.8 Five-year survival rates for African- Americans have improved over the last 30 years but are still less than Whites, at 93% versus 98%.9 Recently, a study based on incidence-based mortality rate (IBM), which takes mortality rate and goes back in time to assess various factors associated with diagnosis of disease, showed that higher mortality in African-Americans may be due to reporting with advanced-stage disease, and not due to a difference in the number of primary tumors or treatment. This approach is different from the survival approach, where a specific group with disease is followed to their eventual vital status.10
Familial Factors
There is an increase in incidence of prostate cancer in persons with a history of prostate cancer in their family – about two to four times higher than in control populations. Those with a family history of prostate cancer tend to have their disease diagnosed six or seven years earlier than controls.11 Family history and hereditary factors are estimated to be important in 5% to 10% of all prostate cancers, and 40% of those cancers diagnosed below the age of 55.The clinical presentation of familial prostate cancer is not sporadic in cancer in presenting at an earlier age, and there is no difference in stage or grade. The factors responsible may be an inherited gene or exposure to a similar environmental factor, or it may simply be that as it is a common disease, it is due to chance alone.
References:
REFERENCES
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8. Clegg L X, Li F P, Hankey B F, Chu K and Edwards B K, "Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study", Arch. Intern. Med. (2002), 162 (17): pp. 1,985-1,993.
9. Bianco F J Jr,Wood D P Jr, Grignon D J, Sakr W A, Pontes J E and Powell I J, "Prostate cancer stage shift has eliminated the gap in disease-free survival in black and white American men after radical prostatectomy", J.Urol. (2002), 168 (2): pp. 479-482.
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11. Bratt O, "Hereditary prostate cancer: clinical aspects", J. Urol. (2002), 168 (3): pp. 906-913.
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35. Klein E A,"Selenium: epidemiology and basic science", J. Urol. (2004), 171 (2 Pt 2): pp. S50-53; discussion p. S53.
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1. Parkin D M, Bray F I and Devesa S S,"Cancer burden in the year 2000.The global picture", Eur. J.Cancer (2001), 37 Suppl 8: pp. S4-66.
2. American Cancer Society, Cancer Facts & Figures 2004, November 2004.
3. Quinn M and Babb P, "Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons", BJU Int. (2002), 90 (2): pp. 162-173.
4. Lunenfeld B, "The ageing male: demographics and challenges",World J. Urol. (2002), 20 (1): pp. 11-16.
5. Jemal A, Murray T, Samuels A, Ghafoor A,Ward E and Thun M J,"Cancer statistics, 2003", CA Cancer J. Clin. (2003), 53 (1): pp. 5-26.
6. Carter H B, Piantadosi S and Isaacs J T,"Clinical evidence for and implications of the multistep development of prostate cancer", J. Urol. (1990), 143 (4): pp. 742-746.
7. Scher H I, Issac J T and Zelefsky M J,"Prostate cancer", In:Abeloff M D,Armitage J O, Licher A S (eds), Clinical Oncology 2nd edn. New York: Churchill Livingstone, pp. 1,823-1,884.
8. Clegg L X, Li F P, Hankey B F, Chu K and Edwards B K, "Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study", Arch. Intern. Med. (2002), 162 (17): pp. 1,985-1,993.
9. Bianco F J Jr,Wood D P Jr, Grignon D J, Sakr W A, Pontes J E and Powell I J, "Prostate cancer stage shift has eliminated the gap in disease-free survival in black and white American men after radical prostatectomy", J.Urol. (2002), 168 (2): pp. 479-482.
10. Merrill R M and Lyon J L, "Explaining the difference in prostate cancer mortality rates between white and black men in the United States", Urology (2000), 55 (5): pp. 730-735.
11. Bratt O, "Hereditary prostate cancer: clinical aspects", J. Urol. (2002), 168 (3): pp. 906-913.
12. Makridakis N M and Reichardt J K, "Molecular epidemiology of androgen-metabolic loci in prostate cancer: predisposition and progression", J. Urol. (2004), 171 (2 Pt 2): pp. S25-28; discussion pp. S28-29.
13. Schaid D J,"The complex genetic epidemiology of prostate cancer", Hum. Mol. Genet. (2004), 13 Spec No 1: pp. R103-121.
14. Lichtenstein P, Holm N V,Verkasalo P K, Iliadou A, Kaprio J, Koskenvuo M et al., "Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland", N. Engl. J. Med. (2000), 343 (2): pp. 78-85.
15. Carter B S, Bova G S, Beaty T H, Steinberg G D, Childs B, Isaacs W B et al., "Hereditary prostate cancer: epidemiologic and clinical features", J. Urol. (1993), 150 (3): pp. 797-802.
16.Tulinius H, Egilsson V, Olafsdottir G H and Sigvaldason H, "Risk of prostate, ovarian, and endometrial cancer among relatives of women with breast cancer", BMJ (1992), 305 (6858): pp. 855-857.
17. Isaacs S D, Kiemeney L A, Baffoe-Bonnie A, Beaty T H and Walsh P C,"Risk of cancer in relatives of prostate cancer probands", J. Natl. Cancer Inst. (1995), 87 (13): pp. 991-996.
18. Smith J R, Freije D, Carpten J D, Gronberg H, Xu J, Isaacs S D et al., "Major susceptibility locus for prostate cancer on chromosome 1 suggested by a genome-wide search", Science (1996), 274 (5291): pp. 1,371-1,374.
19. Gronberg H, Isaacs S D, Smith J R, Carpten J D, Bova G S, Freije D et al., "Characteristics of prostate cancer in families potentially linked to the hereditary prostate cancer 1 (HPC1) locus", JAMA (1997), 278 (15): pp. 1,251-1,255.
20. Xu J, "Combined analysis of hereditary prostate cancer linkage to 1q24-25: results from 772 hereditary prostate cancer families from the International Consortium for Prostate Cancer Genetics", Am. J. Hum. Genet. (2000), 66 (3): pp. 945-957.
21. Carpten J, Nupponen N, Isaacs S, Sood R, Robbins C, Xu J et al., "Germline mutations in the ribonuclease L gene in families showing linkage with HPC1", Nat. Genet. (2002), 30 (2): pp. 181-184.
22. Nakazato H, Suzuki K, Matsui H, Ohtake N, Nakata S and Yamanaka H,"Role of genetic polymorphisms of the RNASEL gene on familial prostate cancer risk in a Japanese population", Br. J. Cancer (2003), 89 (4): pp. 691-696.
23. Wiklund F, Jonsson B A, Brookes A J, Stromqvist L,Adolfsson J, Emanuelsson M et al.,"Genetic analysis of the RNASEL gene in hereditary, familial, and sporadic prostate cancer", Clin. Cancer Res. (2004), 10 (21): pp. 7,150-7,156.
24. Simard J, Dumont M, Soucy P and Labrie F,"Perspective: prostate cancer susceptibility genes", Endocrinology (2002), 143 (6): pp. 2,029-2,040.
25. Makridakis N M, Ross R K, Pike M C, Crocitto L E, Kolonel L N, Pearce C L et al., "Association of mis-sense substitution in SRD5A2 gene with prostate cancer in African-American and Hispanic men in Los Angeles, USA", Lancet (1999), 354 (9183): pp. 975-978.
26. Shimizu H, Ross R K, Bernstein L,Yatani R, Henderson B E and Mack T M, "Cancers of the prostate and breast among Japanese and white immigrants in Los Angeles County", Br. J. Cancer (1991), 63 (6): pp. 963-966.
27. Fleshner N, Bagnell P S, Klotz L and Venkateswaran V, "Dietary fat and prostate cancer", J. Urol. (2004), 171 (2 Pt 2): pp. S19-24.
28. Whittemore A S, Kolonel L N,Wu A H, John E M, Gallagher R P, Howe G R et al.,"Prostate cancer in relation to diet, physical activity, and body size in blacks, whites, and Asians in the United States and Canada", J. Natl. Cancer Inst. (1995), 87 (9): pp. 652-661.
29. Gronberg H,"Prostate cancer epidemiology", Lancet (2003), 361 (9360): pp. 859-864.
30. Shirai T, Asamoto M,Takahashi S and Imaida K, "Diet and prostate cancer", Toxicology (2002), pp. 181-182, pp. 89-94.
31. Chan J M, Stampfer M J, Giovannucci E, Gann P H, Ma J,Wilkinson P et al.,"Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study", Science (1998), 279 (5350): pp. 563-566.
32. Stattin P, Bylund A, Rinaldi S, Biessy C, Dechaud H, Stenman U H et al., "Plasma insulin-like growth factor-I, insulin-like growth factor-binding proteins, and prostate cancer risk: a prospective study", J. Natl. Cancer Inst. (2000), 92 (23): pp. 1,910-1,917.
33. Miller E C, Giovannucci E, Erdman J W Jr, Bahnson R, Schwartz S J and Clinton S K,"Tomato products, lycopene, and prostate cancer risk", Urol. Clin. North Am. (2002), 29 (1): pp. 83-93.
34. Giovannucci E, Rimm E B, Colditz G A, Stampfer M J, Ascherio A, Chute C C et al.,"A prospective study of dietary fat and risk of prostate cancer", J. Natl. Cancer Inst. (1993), 85 (19): pp. 1,571-1,579.
35. Klein E A,"Selenium: epidemiology and basic science", J. Urol. (2004), 171 (2 Pt 2): pp. S50-53; discussion p. S53.
36. Kristal A R, "Vitamin A, retinoids and carotenoids as chemopreventive agents for prostate cancer", J. Urol. (2004), 171 (2 Pt 2): pp. S54-58; discussion p. S58.
37. Clark L C, Combs G F Jr,Turnbull B W, Slate E H, Chalker D K, Chow J et al., "Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin", A randomized controlled trial. Nutritional Prevention of Cancer Study Group, JAMA (1996), 276 (24): pp. 1,957-1,963.
38. Heinonen O P, Albanes D,Virtamo J,Taylor P R, Huttunen J K, Hartman A M et al., "Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial", J. Natl. Cancer Inst. (1998), 90 (6): pp. 440-446.
39. Huggins C and Hodges C V, "Studies on prostate cancer, effect of castration, of estrogen and of androgen injection of serum phosphatases in metastatic carcinoma of the prostate", Cancer Res. (1941), 1: pp. 293-297.
40. Haas G P and Sakr W A,"Epidemiology of prostate cancer", CA Cancer J. Clin. (1997), 47 (5): pp. 273-287
41. Hsing A W,"Hormones and prostate cancer: what's next?", Epidemiol Rev. (2001), 23 (1): pp. 42-58.
42. Calle E E, Rodriguez C,Walker-Thurmond K and Thun M J,"Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults", N. Engl. J. Med. (2003), 348 (17): pp. 1,625-1,638.
43. Zhang Y, Kiel D P, Ellison R C, Schatzkin A, Dorgan J F, Kreger B E et al., "Bone mass and the risk of prostate cancer: the Framingham Study", Am. J. Med. (2002), 113 (9): pp. 734-739. Notes: CORPORATE NAME: Framingham Study.
44. Chan J M, Stampfer M J, Ma J, Gann P H, Gaziano J M and Giovannucci E L,"Dairy products, calcium, and prostate cancer risk in the Physicians' Health Study", Am. J. Clin. Nutr. (2001), 74 (4): pp. 549-554.
45. Hickey K, Do K A and Green A,"Smoking and prostate cancer", Epidemiol. Rev. (2001), 23 (1): pp. 115-125
46. Dennis L K and Hayes R B, "Alcohol and prostate cancer", Epidemiol. Rev. (2001), 23 (1): pp. 110-114.
47. Lee I M, Sesso H D, Chen J J and Paffenbarger R S Jr."Does physical activity play a role in the prevention of prostate cancer?", Epidemiol. Rev. (2001), 23 (1): pp. 132-137.
48. Leitzmann M F, Platz E A, Stampfer M J, Willett W C and Giovannucci E, "Ejaculation frequency and subsequent risk of prostate cancer", JAMA (2004), 291 (13): ppp. 1,578-1,586.
49. Peterson H B and Howards S S, "Vasectomy and prostate cancer: the evidence to date", Fertil. Steril. (1998), 70 (2): pp. 201-203. Notes: GENERAL NOTE: PIP:TJ: FERTILITY AND STERILITY.
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