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Risks and causes of prostate cancer

Prostate cancer is now the most common cancer in men in the UK (not counting non melanoma skin cancer).  There are some risk factors that we know about.

As men get older their risk of prostate cancer goes up. Between 2009 and 2011, around a third of all cases in the UK were diagnosed in men over 75. It is quite rare in men under 50.

You may also be more at risk if you

  • Have a family history of prostate or breast cancer
  • Are of African or Caribbean ancestry – prostate cancer is more common in black men than white or Asian men
  • Asian men have a lower risk than white men

Your diet may affect your risk. There is a lot of research going on and the evidence is not strong but you may increase your prostate cancer risk if you eat a diet high in dairy products. There is some evidence that lycopene from tomatoes (especially cooked or processed tomatoes) may lower the risk.

Some studies have shown that having diabetes may reduce the risk of prostate cancer. There is also some evidence that regularly taking aspirin or other non steroidal anti inflammatory drugs (NSAIDs) could reduce the risk.

 

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How common prostate cancer is

Prostate cancer is now the most common cancer in men in the UK (not counting non melanoma skin cancer). More than 41,700 men are diagnosed each year. That is almost a quarter of all cancers diagnosed in men.

 

What risk factors are

A risk factor is anything that can increase your chance of developing cancer. Different cancers have different risk factors. Some factors can lower your risk of cancer and are known as protection factors.

 

Risk factors for prostate cancer

We don't know exactly what causes prostate cancer. But research shows that some factors may affect your risk. We are still unclear about the link between some of these factors and prostate cancer risk.

 

Age

Age is the most significant risk factor for prostate cancer. Your risk increases as you get older. Prostate cancer is quite rare in men under 50. Between 2009 and 2011, around a third of all cases in the UK were diagnosed in men over 75. And only 1 out of every 100 (1%) of cases were diagnosed in men under 50. In old age, up to 8 out of 10 men (80%) have prostate cancer cells in the prostate but in some men they don't cause any problems..

No one can give you an exact figure of risk. In the UK, about 1 in 8 men will get prostate cancer at some point in their lives. Remember, this is a lifetime risk and involves men who get prostate cancer at any age, up to 85 or older. Your risk when you are younger is much lower than 1 in 8.

 

A family history of cancer

A family history means that you have someone in your family who has cancer. Generally speaking, if you have a father or brother diagnosed with prostate cancer you are 2 to 3 times more likely to get prostate cancer yourself, compared to the average man. The age that your relative is diagnosed with prostate cancer may also be a factor. If they were diagnosed before the age of 60, this increases your risk by slightly more than if they were diagnosed after the age of 60. If you have more than one first degree relative diagnosed with prostate cancer (at any age) your risk is about 4 times that of the general population.

It could be a sign that you have an inherited faulty gene in the family if 

  • You have a relative who was young when they were diagnosed with prostate cancer
  • Or you have several relatives with prostate cancer

The younger the age at diagnosis, the more likely it is that an inherited faulty gene is the cause. Remember that for there to be a faulty gene at work, the affected relatives have to come from the same side of your family (your mother's side or your father's side).

Men who have first degree relatives with breast cancer may also have a higher risk of prostate cancer, particularly if the family members were diagnosed under the age of 60. This increased risk is mainly caused by an inherited faulty gene called BRCA2. Men who have a fault (mutation) in the BRCA2 gene can have a risk of prostate cancer that is 5 times higher than men in the general population. The risk can be 7 times higher in men under the age of 65.

Faults in a gene called BRCA1 may increase the risk of developing prostate cancer in men under the age of 65 by a small amount. But in men older than 65 who have a faulty BRCA1 gene there doesn’t appear to be an increased risk.

It is important to remember that statistics are always a generalisation. There are likely to be specific factors at work for some men, which increase their risk.

 

Genes

Scientists are working on identifying other genes that may increase the risk of prostate cancer. In 2008, Cancer Research UK scientists identified 7 gene changes that increase the risk of prostate cancer. In the future, they may develop a test, to see if men are carrying any of these genes.

People with Lynch syndrome have inherited faulty genes that increase their risk of developing certain cancers. Researchers have found that men with Lynch syndrome may have a higher risk of prostate cancer than men in the general population.

 

Ethnicity

Prostate cancer is more common in black Caribbean and black African men than in white or Asian men. In the UK, black African and black Caribbean men are 2 or 3 times more likely to develop prostate cancer than white men. Asian men have a lower risk than white men.

This difference seems to be due to a mixture of inherited genes and environmental factors. When men move from a country where the prostate cancer risk is low to one where it is higher their risk increases. For example, South Asian men living in the UK have a higher risk of prostate cancer than men living in South Asia.

 

A previous cancer

Men who have had certain cancers in the past, may have a slightly increased risk of getting prostate cancer. Studies have shown an increase in risk for men who have had kidney cancer, bladder cancer, lung cancer, thyroid cancer and melanoma skin cancer.

 

Calcium in your diet

We still don’t fully understand how diet affects prostate cancer risk. Several factors have been studied. Some studies show that men who have diets high in calcium may have a higher risk of prostate cancer.

 

Height and body weight

Research has shown that taller men have a higher risk than shorter men of getting faster growing (high grade) prostate cancer, or prostate cancer that has spread.

Being overweight for your height (obese) may also affect your risk. Some studies have found that having a high body mass index (BMI) increases your risk of dying from prostate cancer or being diagnosed with high grade prostate cancer. But it lowers your risk of getting localised prostate cancer. Doctors think that these results may partly be because it is harder to diagnose and treat prostate cancer in obese men.

 

Hormones

Hormone levels may or may not play a part in the risk of developing prostate cancer. The prostate gland is a sex organ. It produces a liquid that is mixed with sperm to make semen. Testosterone is a sex hormone produced by the testicle and the prostate gland needs testosterone to work. It was thought in the past that having higher levels of testosterone in the blood may increase the risk of prostate cancer. But, in 2008 an analysis of 18 separate studies found no link between levels of sex hormones and prostate cancer risk.

 

IGF-1 (insulin like growth factor)

Insulin like growth factor is a normal chemical that our body makes. It is involved in the regulation of normal cell growth and death. Some studies have shown that men with a higher level of IGF-1 in the blood have a higher risk of prostate cancer. 

 

Vasectomy

A large study reported in the USA in 2014. It showed a small increased risk of prostate cancer in men who have had a vasectomy. Vasectomy is a procedure for male sterilisation and permanent birth control. Two other large studies in 1993 also found a small increase in risk but other studies have not shown an increased risk. It seems likely that vasectomy does increase the risk of prostate cancer but the increase in risk is very small.

 

Cadmium

Cadmium is a natural metal in the environment. Small amounts can be found in our foods. There is limited evidence that a diet which contains a high amount of cadmium may increase your risk of getting prostate cancer.

 

Inflammation of the prostate

Inflammation of the prostate is called prostatitis. A meta-analysis published in 2013 combined the information from 20 studies looking at prostate cancer risk and prostatitis. It found that men with prostatitis had a higher risk of prostate cancer. But the meta-analysis included low quality research studies. The results from another higher quality study did not find a link between prostatitis and prostate cancer.  So we need more research before we know whether prostatitis increases your risk of prostate cancer.

 

Protection factors for prostate cancer

Your risk of prostate cancer may be lowered by the following factors.

Diet factors and vitamin supplements

Eating a healthy diet can lower your risk of many cancers. Many studies have looked at dietary factors and prostate cancer risk. This type of research is difficult. We all eat such a variety of different things that any link between diet and illness is very difficult to prove. Much of the research has not found any definite links between particular foods and the risk of prostate cancer. Foods that have been studied include

  • Fat and meat
  • Fruit and vegetables
  • Vitamin E
  • Green tea
  • Soy

Recently, though, reviews of the evidence have found that foods containing lycopene and selenium probably reduce the risk of prostate cancer.

  • Lycopene is found mainly in tomatoes and tomato based foods, with especially high levels in cooked and processed tomato products
  • Selenium is a naturally occurring chemical found in plant foods (such as vegetables) fish, shellfish, some meats, grains, eggs, Brewer's yeast, and wheat germ

Researchers want to find out whether taking certain vitamin or mineral supplements lowers your risk of getting prostate cancer. They have looked at selenium supplements, but at the moment there is no strong evidence that selenium supplements can prevent prostate cancer. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) studied the effects of selenium and vitamin E supplements on prostate cancer risk. In the study, men either took one or both of these supplements or an inactive placebo, each day for about 5 years. Neither vitamin E nor selenium supplements were found to lower prostate cancer risk. And men who took vitamin E supplements had a slightly higher risk of prostate cancer.

These findings may have been influenced by certain factors. For example, the dose and type of selenium used, and the men’s selenium levels before they started taking the supplement.  The age of the men may also have affected the results. We need more research to find out whether or not these supplements can affect your risk of prostate cancer.

Diabetes

Men with diabetes mellitus may have a lower risk of prostate cancer than the average man. Diabetes is an illness in which the pancreas does not produce enough of a hormone called insulin. We don't know why diabetes could reduce the risk of prostate cancer. Research into this issue is coming up with contradictory results at the moment. But it may be something to do with a change in normal insulin production in diabetes affecting the level of a growth factor called IGF-1 in the blood.

Aspirin 

There is some evidence that taking aspirin regularly may slightly reduce the risk of prostate cancer. Research has also looked at other non steroidal anti inflammatory drugs (NSAIDs), such as the painkiller ibuprofen (Nurofen or Brufen). Some studies have shown a reduced risk of prostate cancer in people taking these drugs. But, others studies have not and so overall the picture is unclear.

It is important to remember that doctors and scientists don't recommend taking aspirin or other NSAIDs regularly. These drugs can damage the lining of your stomach and cause bleeding. Don't take aspirin or other NSAIDs regularly without checking with your doctor first.

Physical activity

Some, but not all, the studies looking at physical activity and prostate cancer have found that men who are more physically active have a lower risk of getting prostate cancer. A recent review of the research evidence found that being active, especially in the work place, slightly reduced the chance of getting prostate cancer. But many low quality research studies were included in this review. So we need more research to find out how physical activity affects risk.

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Updated: 6 June 2014