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Epidemiology and classification

Risk Factors

Although many potential predisposing factors for prostate cancer have been investigated, only three risk factors are well-established: age, family history and ethnicity¹.  The existence of environmental (and therefore potentially modifiable) risk factors for prostate cancer is suggested by the increase in risk observed when migrants move from low-risk to high-risk countries.^2,3 Nonetheless, the exogenous factors explaining this observation have yet to be precisely defined.³ Unlike many other tumour types, smoking, alcohol and sedentary lifestyle do not appear to play a role in the development of prostate cancer⁴. Patient information on this topic can be found at Unitedagainstprostatecancer.com.

• Age: Prostate cancer is rare before the age of 50, but the incidence increases sharply thereafter. The mean age at diagnosis is 72–74 years and 85% of cases are identified following the 65th year.⁴ Post-mortem studies reveal that around 80% of men ≥70 years dying of non-prostate cancer causes have evidence of prostatic neoplasia, although it should be recognised that not all these tumours are destined to become clinically significant⁵. 
• Family history: People with a family history of prostate cancer in a first-degree relative (i.e. father or brother) have an approximately 2–3-fold increased risk of developing the disease compared with those without affected relatives^6,7. The risk appears highest if the relative developed prostate cancer at an early age (<60 years), and the presence of multiple affected first-degree relatives confers even greater risk.^6,7 Several candidate susceptibility genes have been identified that may contribute to the inherited predisposition⁸.
• Ethnicity: In the UK, the incidence of prostate cancer is around 3-fold higher in black men compared with white men⁹.  In contrast, men of Bangladeshi or Chinese ethnicity living in the UK have significantly lower rates of prostate cancer than white men¹⁰.
• Diet: A body of epidemiological evidence corroborates a ‘Western’ diet enriched in calcium, fat and red meat and low in fibre, fruit and vegetables as increasing the risk of prostate cancer. Food supplements containing selenium, vitamin E, flavonoids or lycopene are widely used to prevent or treat, although no benefit has been demonstrated.⁴ 

References:
1. European Association of Urology. Guidelines on prostate cancer, 2010.
2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
3. Carpenter WR, Robinson WR, Godley PA. Getting over testosterone: postulating a fresh start for etiologic studies of prostate cancer. J Natl Cancer Inst 2008;100:158-9.
4. Grönberg H. Prostate cancer epidemiology. Lancet 2003;361:859-64.
5. Sakr WA, Grignon DJ, Haas GP, Heilbrun LK, Pontes JE, Crissman JD. Age and racial distribution of prostatic intraepithelial neoplasia. Eur Urol 1996;30:138-44.
6. Steinberg GD, Carter BS, Beaty TH, Childs B, Walsh PC. Family history and the risk of prostate cancer. Prostate 1990;17:337-47.
7. Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int 2003;91:789-94.
8. Thomas G, Jacobs KB, Yeager M, et al. Multiple loci identified in a genome-wide association study of prostate cancer. Nat Genet 2008;40:310-5.
9. Ben-Shlomo Y, Evans S, Ibrahim F, et al. The risk of prostate cancer amongst black men in the United Kingdom: the PROCESS cohort study. Eur Urol 2008;53:99-105.
10. Jack RH, Davies EA, Møller H. Testis and prostate cancer incidence in ethnic groups in South East England. Int J Androl 2007;30:215-20.

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