Prostate Cancer Risk
Epidemiology and Genetics
Robert F. Marschke, Jr., M.D.
November 2, 2013
PROSTATE CANCER
RISK FACTORS
Age
The risk of prostate cancer rises rapidly after age 50 years
PROSTATE CANCER
RISK FACTORS
Race / Ethnicity
Compared to non-Hispanic white men, prostate cancer occurs:
More often in African-American men
Less often in Asian-American and Hispanic/Latino men
PROSTATE CANCER
RISK FACTORS
Nationality / Geography
More common in North America, northwestern Europe,
Australia, Caribbean islands
Less common in Asia, Africa,
Central and South America
PROSTATE CANCER
RISK FACTORS
Dietary habits may increase risk:
Lots of red meat and/or high-fat dairy products
Few fruits and vegetables
Very high calcium intake
PROSTATE CANCER
RISK FACTORS
Obesity
Most studies have not found obesity linked
to a higher risk prostate cancer
Some studies suggest a higher risk of aggressive prostate
cancer and death due to prostate cancer in obese men
PROSTATE CANCER
RISK FACTORS
Workplace Exposures
There is some evidence that firefighters’ exposures to dust and
smoke and other substances may increase risk
World Trade Center rescue / recovery workers were exposed to pollutants and carcinogens,
and from 2001 to 2008, 20,984 participated in the WTC Health Program
575 cancers were found in 552 individuals with increased relative risk for all cancer sites,
especially those highly exposed and exposed to significant amounts of dust
The relative risk of prostate cancer was 1.44
(National Institute of Environmental Health Science)
PROSTATE CANCER
RISK FACTORS
Smoking
Most studies have not found a link between smoking
and the risk of developing prostate cancer
Some studies linked smoking to a possible small increase
in the risk of death from prostate cancer, a finding that
will need to be confirmed
PROSTATE CANCER
RISK FACTORS
Inflammation of the Prostate (Prostatitis)
Inflammation is often seen in samples of prostate
gland tissue that also contain cancer
Inflammation may be linked to an
increased risk of prostate cancer
This is an active area of research
PROSTATE CANCER
RISK FACTORS
Sexually Transmitted Infections
May lead to inflammation of the prostate gland
Studies so far have no firm conclusions
PROSTATE CANCER
RISK FACTORS
Vasectomy
Most recent studies have not found any increased risk
among men who have had this operation
Fear of an increased risk of prostate cancer should
not be a reason to avoid a vasectomy
1953
James Watson and Francis Crick
X-ray diffraction “Photo 51”
A vague image of DNA
PROSTATE CANCER
RISK FACTORS
Family History
Having a father or brother with prostate cancer
more than doubles risk
Risk is much higher for men with several affected relatives
especially with young ages at the time of diagnosis
Relative Risk
Family History of Prostate Cancer
Father diagnosed at any age
2.35
Brother(s) diagnosed at any age
3.14
Two or more FDRs any age
4.39
FDR = first-degree relative
PROSTATE CANCER
RISK FACTORS
Genetics
Few familial prostate cancers have been
proven to be inherited (5%)
Genetic testing for most of these is not available
BRCA1 or BRCA2 mutations (breast and ovarian cancers),
account for a small percentage of prostate cancers
PROSTATE CANCER
RISK FACTORS
Genetics
Other inherited mutated genes associated with prostate cancer are
HPC1 (Hereditary Prostate Cancer Gene 1) and HOXB13
The clinical utility of testing for these
mutations has not yet been defined
Note: most DNA mutations related to prostate cancer develop
during a man's lifetime rather than having been inherited
Mitochondria are membrane-enclosed structures in our cells
Each mitochondrion has its own DNA (similar to bacteria)
Mitochondria and mitochondrial DNA come from the egg only
(maternal inheritance)
Mitochondrial DNA mutations often present as neurological
diseases, but they can also present as other diseases
Mitochondrial DNA
Mutations
May increase the cancer rate to
four times that of the general population
A retrospective evaluation of 470 patients with
mitochondrial disorders showed 65 malignancies
In men, prostate cancer was the most common malignancy
Josef Finsterer, MD, PhD, Neurology Department, Krankenanstalt Rudolfstiftung, Vienna, Austria.
XXI World Congress of Neurology (WCN). Free Papers Session 13. Presented September 23, 2013.
Conclusions
Prostate Cancer Risk
Epidemiology and Genetics
Things We Cannot Control
Family History / Genetics
Race / Ethnicity
Age
Conclusions
Prostate Cancer Risk
Epidemiology and Genetics
Things We Can Control
Our Dedication to Science
Nationality / Geography
Workplace Exposures
Smoking
Obesity
Diet
The End
Happy Trails
to You!
Thank you!