Prostate cancer risk factors
No established modifiable risk factor for prostate cancer has been identified and therefore, at present, there is insufficient evidence on which to base a prevention strategy. The established risk factors are age, family history and ethnicity.
Many other factors have been studied but the evidence for most of them remains inconclusive or conflicting. One reason for this may be that different factors are involved in the development and promotion of aggressive disease compared with non-aggressive disease, making epidemiological studies of prostate cancer particularly complex.1
Interpretation of prostate cancer risk factors has been further complicated in the PSA testing era, when identification of many prostate cancers is dependent on a threshold PSA level, which in turn is affected by other exposures such as body mass. This blurs the distinction between ‘cases’ and ‘controls’ leading to the possibility of PSA-detection bias.2
Meta-analyses and systematic reviews are cited on this page where available, as they provide the best overview of all available research and most take study quality into account. Individual case-control and cohort studies are reported where such aggregated data are lacking.
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A history of prostate cancer in a first-degree relative increases risk of the disease by 120–150%.3-5 The risk for men with an affected father is increased by 112–140%, while those with an affected brother have a 187–230% risk increase.3-5 The risk increase is higher when more than one first-degree relative is affected; for men aged under 65 years (compared with older men); and for men with a relative diagnosed before the age of 60.4-6 Risk is also increased, by 90–150%, for men with an affected second-degree relative.3,5
Men with a mother diagnosed with breast cancer have a 19–24% increased risk of prostate cancer, according to studies conducted in the United States and Sweden.6,7 Risk does not appear to be increased for men with a sister diagnosed with breast cancer.6,7
Germline mutations in the breast cancer susceptibility gene, BRCA2, can predispose men to prostate cancer, increasing the risk of developing prostate cancer up to five times in men overall, and more than seven times in men aged under 65.8 Mutations in the BRCA1 gene may increase the risk of developing prostate cancer in men under the age of 65 by a small amount, and there doesn’t appear to be an increased risk after this age.9,10
Recently, genome-wide association studies have identified several genetic variants that each slightly increase prostate cancer risk.11-18 However, because such genetic variants are common in the population, they may contribute to a significant proportion of all prostate cancer cases. Current research in this area is likely to identify further variants in the next few years. Genetic profiling is being used to inform prostate screening and treatment.
Overall, around 5–9% of prostate cancers are linked to genes and family history, it is estimated.19
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Black men have a higher risk of prostate cancer than white men, while men of Asian and Chinese ethnicity have a lower risk than white men, the latest England-wide data show.20 There are similar differences by major ethnic group in the United States.21 Compared to men born in England and Wales, men born in West Africa or the Caribbean, but resident in England and Wales, have standardised mortality ratios (SMRs) for prostate cancer of 271 and 198, while men born in India, Pakistan, Bangladesh and China and Hong Kong have SMRs between 21 and 72 (a SMR of 100 indicates a mortality rate similar to the whole population of England and Wales).22
The risk increase associated with black ethnicity is higher at younger ages, a cohort study shows, and black men may be diagnosed on average three–five years younger than white men, although firm conclusions about differences in the average age at diagnosis between ethnic groups are hampered by differences in the underlying population age distribution within these groups.23-25
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Men with the highest levels of insulin-like growth factor-1 (IGF-1) have a 38–83% increased risk of prostate cancer.26,27 The risk increase is stronger in studies where blood tests were taken after diagnosis of cancer (retrospective studies) but is also shown in prospective studies.28,29 Both a positive and negative association of prostate cancer risk with blood levels of IGF binding protein-3 (IGFBP-3) has been shown.27,28 Levels of IGF-2 and IGFBP-1 and IGFBP-2 do not appear to be associated with prostate cancer risk.27,28
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Risk of advanced, aggressive, or fatal prostate cancer increases by 12% for every 10cm increase in height, according to a meta-analysis.30 Overall prostate cancer risk is 5% higher per 5cm increment in height, a pooled analysis of Nordic data showed.120
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Men with a previous renal cell (kidney) cancer have an increased risk of prostate cancer, with a recent study showing a 69% increased risk.31,32 Risk associated with previous kidney cancer appears to be higher for men with a family history of prostate cancer.33 A 14–151% increased risk has been shown in various studies for men with a previous bladder cancer.33-36 This is at least partly due to detection bias, it has been suggested, although genetic factors may also play a role.34,35 Men with a previous melanoma have a 15–50% increased risk of prostate cancer, studies show.33,37-39 Men with a previous lung adenocarcinoma have a 56% increased risk of prostate cancer, according to an international registry study.40 A previous thyroid cancer has also been associated with an increased risk.41
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The International Agency for Research on Cancer (IARC) states that there is limited evidence that exposure to thorium-232 and its decay products, and gamma and x-rays increases prostate cancer risk.42 The risk increase for prostate cancer in atomic bomb survivors is consistent with that for all solid cancers.43
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Carotenoids and selenium
Foods containing lycopene (a carotenoid, or type of plant vitamin A) and selenium (a trace mineral) probably protect against prostate cancer, according the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR).44 Men with higher body levels (in blood or nail samples) of selenium have a 26–71% reduced risk of prostate cancer, according to meta-analyses.45,46 Men with the highest blood levels of lycopene have a 16–24% reduction in risk of prostate cancer, according to meta-analyses, although the lower, more recent, estimate was not statistically significant.47,48 Men with the highest intakes of lycopene have an 11% reduction in risk of prostate cancer, according to the earlier meta-analysis.48 Randomised controlled trials (RCTs) carried out to date do not show a reduced risk of prostate cancer in men receiving lycopene or selenium supplements.46,49,50
There is no association with blood levels of the other main individual carotenoids.47 Higher blood levels of total carotenoids were linked to a 65% reduced risk of advanced prostate cancer in a European cohort study, although it is possible that the association is due to another unidentified lifestyle factor associated both with a reduced likelihood of detection of prostate cancer at an early stage and lower intake of carotenoids.47
Current regular, long-term use of acetaminophen (>30 pills per month for at least five years) was linked to a 38% reduced risk of prostate cancer overall, and a 51% reduced risk of aggressive prostate cancer in a long-term study.53
Men with exposure to warfarin (a vitamin K antagonist, or anticoagulant) have a 17–31% reduced risk of prostate cancer, cohort and case-control studies show.54-56
Men with diabetes have a lower risk of prostate cancer, with the most recent meta-analysis showing a 21% reduction in risk for diabetic men in studies conducted in the United States only, and a similar risk reduction for men who had been diagnosed with diabetes between five and ten years earlier, but not for more a more recent diabetes diagnosis.57
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Testosterone is involved in growth of prostate cancer, but men with higher levels of testosterone in their blood prior to diagnosis do not appear to have a higher risk of prostate cancer.58 Risk of prostate cancer is also unrelated to levels of other androgens and oestrogen.58
A five-point increase in body mass index (BMI) is associated with a 9–15% increased risk of advanced prostate cancer or prostate cancer death, but with a 4–6% reduced risk of localised prostate cancer.59-61 Reduced likelihood of detecting prostate cancer at an early stage in obese men compared with those with a healthy bodyweight may partially explain the association of obesity with advanced prostate cancer, it has been suggested.61
Baldness at the age of 40 was associated with an 81% increased risk of prostate cancer before the age of 55, but a 44% reduction in risk for men aged 75 or older, in a recent cohort study.62 However, findings from earlier studies of baldness and prostate cancer have been inconsistent.
Heavy/long-term smoking is associated with an 11–22% increase in risk of prostate cancer, and current smokers have a 14% increased risk of dying of prostate cancer, with a risk increase of 24–30% for those with the highest exposures, according to a meta-analysis.63 There are difficulties in assessing the effect of smoking on prostate cancer risk, however, due to the potential for bias if factors related to prostate cancer risk vary between smokers and non-smokers, for example with regard to screening behaviour. IARC does not currently classify smoking as a cause of prostate cancer.42
Use of smokeless tobacco was linked to a 20% increased risk of prostate cancer in a meta-analysis, but the number of studies was small, and IARC does not classify smokeless tobacco as a cause of prostate cancer.42,64
There is no association between blood vitamin D levels and prostate cancer risk, according to a meta-analysis.65
There is no association between alcohol consumption and prostate cancer risk, meta-analyses show.66-68
Risk of prostate cancer is unrelated to intake of red and processed meat, when factoring in the effect of study quality and publication bias, according to the latest meta-analysis.69
Blood levels of vitamin E and retinol (vitamin A from animal sources) are not associated with prostate cancer risk, a meta-analysis shows.47
Folic acid supplements do not increase prostate cancer risk, according to the latest meta-analysis, and there is no association with blood levels of folate.70,71 These findings conflict with those of an earlier meta-analysis, which showed that men receiving folic acid supplements had a 24% increased risk of prostate cancer.72
Higher intake of dairy products may not be associated with risk of prostate cancer, according to the most recent meta-analysis.73 This contrasts with the results of an earlier meta-analysis, which showed a 12% increase in risk with higher intake of dairy products.74 Higher intake of butter and cheese, although not overall dairy products, may be associated with a 35–45% increased risk of advanced prostate cancer, according to a recent cohort study.75
Results of cohort studies into calcium intake and prostate cancer risk showed high variability and were not combined in the most recent meta-analysis, although an earlier analysis showed a 38% increase in risk with higher intake of calcium.73,74 Risk for total and advanced prostate cancer was increased by 32% and 62%, respectively, in a recent cohort study, and in 2007, the WCRF/AICR stated that there is probable evidence that diets high in calcium increase prostate cancer risk.44,75
Higher intake of alpha-linolenic acid (an omega-3 fatty acid found in plants) has been associated with both a reduction and increase in prostate cancer risk in meta-analyses.76,77 Research in this area is affected by publication bias meaning any effect shown may be spurious.78
High consumption of fish was not shown to affect prostate cancer risk in a meta-analysis of cohort studies, although was linked to a reduced risk of prostate cancer death.85
Green tea has been linked to a 57% reduction in prostate cancer risk in case-control studies, a meta-analysis shows, but as no effect was shown in cohort studies the evidence for an association remains uncertain.86
There is limited evidence that exposure to cadmium and cadmium compounds increases prostate cancer risk, IARC states.42 Cadmium is widely dispersed within the environment and the main source of exposure in non-smokers is through food. Men with the highest dietary exposure have a 29% increased risk of localised prostate cancer, a cohort study shows.89
Men with higher levels of occupational physical activity have a 19% reduced risk of prostate cancer, according to a meta-analysis, but recreational physical activity was shown to have no effect.90
Use of aspirin was linked to a 17% reduced risk of prostate cancer in the most recent meta-analysis, although there was considerable heterogeneity between the individual studies included in the analysis.91 A subsequent study showed a 12% reduced risk of aggressive prostate cancer in men taking at least one aspirin pill a day in the previous 12 months.92 Aspirin use does not reduce risk of prostate cancer death, according to a meta-analysis of RCTs.93 Because of the potential adverse consequences of high intake of aspirin, such as gastrointestinal haemorrhage, it would not be recommended as a prophylactic measure.
No significant effect of non-aspirin NSAIDs was shown in two meta-analyses.91,94 A risk increase for men taking several types of non-aspirin NSAID was shown in a recent study but this was thought to be a result of bias as there was no trend with increasing cumulative usage.95 Use of NSAIDs lowers PSA levels, which is a potential source of bias in studies of prostate cancer risk.96
The majority of meta-analyses of observational studies and RCTs show no effect of statin use on risk of prostate cancer.97-100 There has been one exception to this, where overall use was shown to slightly reduce prostate cancer risk, but long-term use was not.101
Prostatitis (inflammation of the prostate) can be caused by an infection, but in the majority of cases is of unknown cause. A history of prostatitis has been linked to a 60% increased risk of prostate cancer in a meta-analysis.102 Subsequent findings have been conflicting, one large prospective study showing a risk increase for men of all ages, and another showing a risk increase for men aged under 60 but a risk reduction for men aged over 69.103,104 Men with a diagnosis of any benign prostate disease (benign prostatic hyperplasia or prostatitis) in the previous five years have a 57% increased risk of prostate cancer, but the risk increase is limited to the first six months after the diagnosis, and not over a longer period of follow-up, according to a case-control study. This indicates that prostate cancer might be more likely to be incidentally detected during investigation for these conditions, rather than the conditions having a causal role in prostate cancer development.105
Evidence is conflicting about whether previous vasectomy is linked to an increased risk of prostate cancer, but the most comprehensive meta-analysis showed no risk increase.106-108
Men with a previous knee or hip replacement have a 12–19% increased risk of prostate cancer, meta-analyses show.109,110 However, the risk increase begins to occur within five years of the procedure, suggesting that the increased risk is a result of increased likelihood of detection of prostate cancer in this group.110
A history of sexually transmitted infections (STIs) has been linked to prostate cancer in meta-analyses (40–50% risk increase).111,112 However, the majority of studies included in these analyses were retrospective, meaning it is possible the results were affected by recall bias, and recent large prospective studies have shown no association of individual STIs or overall history of STIs with prostate cancer risk.103,104,113 Men with HIV or AIDS are not at an increased risk of prostate cancer, according to meta-analyses.114,115
Meta-analyses have shown a 13–24% increase in prostate cancer risk in men exposed to pesticides in their occupation.116-118 However, problems with comparing incidence of cancer in people in employment with the general population mean that the results may not be reliable. Prostate cancer was excluded from a recent analysis of occupation-related cancer in Britain, implying that there is inadequate evidence to link prostate cancer to occupational exposures.119 IARC states there is limited evidence of an increased risk of prostate cancer in relation to exposure to arsenic and inorganic arsenic compounds and the rubber production industry.42
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- Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer 2007;121:1571-8. http://www.ncbi.nlm.nih.gov/pubmed/17450530.
- Platz EA, De Marzo AM, Giovannucci E. Prostate cancer association studies: pitfalls and solutions to cancer misclassification in the PSA era. J Cell Biochem 2004;91:553-71. http://www.ncbi.nlm.nih.gov/pubmed/14755685.
- Bruner DW, Moore D, Parlanti A, Dorgan J, Engstrom P. Relative risk of prostate cancer for men with affected relatives: systematic review and meta-analysis. Int J Cancer 2003;107:797-803. http://www.ncbi.nlm.nih.gov/pubmed/14566830.
- Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int 2003;91:789-94. http://www.ncbi.nlm.nih.gov/pubmed/12780833.
- Kicinski M, Vangronsveld J, Nawrot TS. An epidemiological reappraisal of the familial aggregation of prostate cancer: a meta-analysis. PLoS One 2011;6:e27130. http://www.ncbi.nlm.nih.gov/pubmed/22073129.
- Hemminki K, Chen B. Familial association of prostate cancer with other cancers in the Swedish Family-Cancer Database. Prostate 2005;65:188-94. http://www.ncbi.nlm.nih.gov/pubmed?term=15948149.
- Chen YC, Page JH, Chen R, Giovannucci E. Family history of prostate and breast cancer and the risk of prostate cancer in the PSA era. Prostate 2008;68:1582-91. http://www.ncbi.nlm.nih.gov/pubmed/18646000.
- Cancer risks in BRCA2 mutation carriers. The Breast Cancer Linkage Consortium. J Natl Cancer Inst 1999;91:1310-6. http://www.ncbi.nlm.nih.gov/pubmed/10433620.
- Thompson D, Easton DF. Cancer Incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002;94:1358-65. http://www.ncbi.nlm.nih.gov/pubmed?term=12237281.
- Fachal L, Gomez-Caamano A, Celeiro-Munoz C, et al. BRCA1 mutations do not increase prostate cancer risk: results from a meta-analysis including new data. Prostate 2011;71:1768-79. http://www.ncbi.nlm.nih.gov/pubmed/21520156.
- Damber JE, Aus G. Prostate cancer. Lancet 2008;371:1710-21. http://www.ncbi.nlm.nih.gov/pubmed?term=18486743.
- Eeles RA, Kote-Jarai Z, Giles GG, et al. Multiple newly identified loci associated with prostate cancer susceptibility. Nat Genet 2008;40:316-21. http://www.ncbi.nlm.nih.gov/pubmed/18264097.
- Amundadottir LT, Sulem P, Gudmundsson J, et al. A common variant associated with prostate cancer in European and African populations. Nat Genet 2006;38:652-8. http://www.ncbi.nlm.nih.gov/pubmed/16682969.
- 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. http://www.ncbi.nlm.nih.gov/pubmed/18264096.
- Zheng SL, Sun J, Cheng Y, et al. Association between two unlinked loci at 8q24 and prostate cancer risk among European Americans. J Natl Cancer Inst 2007;99:1525-33. http://www.ncbi.nlm.nih.gov/pubmed/17925536.
- Haiman CA, Le Marchand L, Yamamato J, et al. A common genetic risk factor for colorectal and prostate cancer. Nat Genet 2007;39:954-6. http://www.ncbi.nlm.nih.gov/pubmed/17618282.
- Gudmundsson J, Sulem P, Rafnar T, et al. Common sequence variants on 2p15 and Xp11.22 confer susceptibility to prostate cancer. Nat Genet 2008;40:281-3. http://www.ncbi.nlm.nih.gov/pubmed?term=18264098.
- Camp NJ, Cannon-Albright LA, Farnham JM, et al. Compelling evidence for a prostate cancer gene at 22q12.3 by the International Consortium for Prostate Cancer Genetics. Hum Mol Genet 2007;16:1271-8. http://www.ncbi.nlm.nih.gov/pubmed?term=17478474.
- Hemminki K, Czene K. Age specific and attributable risks of familial prostate carcinoma from the family-cancer database. Cancer 2002;95:1346-53. http://www.ncbi.nlm.nih.gov/pubmed/12216104.
- National Cancer Intelligence Network and Cancer Research UK. Cancer Incidence and Survival by Major Ethnic Group, England 2002-2006 (PDF 2.6MB). 2009. http://www.ncin.org.uk/view.aspx?rid=75.
- Howlader N NA, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, ed. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2009_pops09/ based on November 2011 SEER data submission, posted to the SEER web site, April 2012.
- Wild SH, Fischbacher CM, Brock A, Griffiths C, Bhopal R. Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001-2003. Br J Cancer 2006;94:1079-85. http://www.ncbi.nlm.nih.gov/pubmed/16523198.
- 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. http://www.ncbi.nlm.nih.gov/pubmed/17368710.
- Karami S, Young HA, Henson DE. Earlier age at diagnosis: another dimension in cancer disparity? Cancer Detect Prev 2007;31:29-34. http://www.ncbi.nlm.nih.gov/pubmed/17303347.
- Metcalfe C, Evans S, Ibrahim F, et al. Pathways to diagnosis for Black men and White men found to have prostate cancer: the PROCESS cohort study. Br J Cancer 2008;99:1040-5. http://www.ncbi.nlm.nih.gov/pubmed/18797456.
- Renehan AG, Zwahlen M, Minder C, O'Dwyer ST, Shalet SM, Egger M. Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet 2004;363:1346-53. http://www.ncbi.nlm.nih.gov/pubmed/15110491.
- Roddam AW, Allen NE, Appleby P, et al. Insulin-like growth factors, their binding proteins, and prostate cancer risk: analysis of individual patient data from 12 prospective studies. Ann Intern Med 2008;149:461-71, W83-8. http://www.ncbi.nlm.nih.gov/pubmed/18838726.
- Rowlands MA, Gunnell D, Harris R, Vatten LJ, Holly JM, Martin RM. Circulating insulin-like growth factor peptides and prostate cancer risk: a systematic review and meta-analysis. Int J Cancer 2009;124:2416-29. http://www.ncbi.nlm.nih.gov/pubmed?term=19142965.
- Price AJ, Allen NE, Appleby PN, et al. Insulin-like growth factor-I concentration and risk of prostate cancer: results from the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev 2012;21:1531-41. http://www.ncbi.nlm.nih.gov/pubmed?term=22761305.
- Zuccolo L, Harris R, Gunnell D, et al. Height and prostate cancer risk: a large nested case-control study (ProtecT) and meta-analysis. Cancer Epidemiol Biomarkers Prev 2008;17:2325-36. http://www.ncbi.nlm.nih.gov/pubmed/18768501.
- Liu H, Hemminki K, Sundquist J. Renal cell carcinoma as first and second primary cancer: etiological clues from the Swedish Family-Cancer Database. J Urol 2011;185:2045-9. http://www.ncbi.nlm.nih.gov/pubmed/21496838.
- Neuzillet Y, Lechevallier E, Coulange C. [Renal cancer and second cancer: critical review of the literature]. Prog Urol 2007;17:35-40. http://www.ncbi.nlm.nih.gov/pubmed?term=17373234.
- Zhang H, Bermejo JL, Sundquist J, Hemminki K. Prostate cancer as a first and second cancer: effect of family history. Br J Cancer 2009;101:935-9. http://www.ncbi.nlm.nih.gov/pubmed/19690542.
- Lehnert M, Kraywinkel K, Pesch B, Holleczek B, Bruning T. New malignancies following cancer of the urinary bladder: analysis of German cancer registry data. Eur J Cancer Care (Engl) 2012;21:398-402. http://www.ncbi.nlm.nih.gov/pubmed/22151945.
- Kellen E, Zeegers MP, Dirx M, et al. Occurrence of both bladder and prostate cancer in five cancer registries in Belgium, The Netherlands and the United Kingdom. Eur J Cancer 2007;43:1694-700. http://www.ncbi.nlm.nih.gov/pubmed/17531466.
- Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 2007;12:20-37. http://www.ncbi.nlm.nih.gov/pubmed/17227898.
- Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol 2010;146:265-72. http://www.ncbi.nlm.nih.gov/pubmed/20231496.
- Kok DE, van de Schans SA, Liu L, et al. Risk of prostate cancer among cancer survivors in the Netherlands. Cancer Epidemiol 2012. http://www.ncbi.nlm.nih.gov/pubmed/23265853.
- Scelo G, Boffetta P, Autier P, et al. Associations between ocular melanoma and other primary cancers: an international population-based study. Int J Cancer 2007;120:152-9. http://www.ncbi.nlm.nih.gov/pubmed/17036322.
- Chuang SC, Scelo G, Lee YC, et al. Risks of second primary cancer among patients with major histological types of lung cancers in both men and women. Br J Cancer 2010;102:1190-5. http://www.ncbi.nlm.nih.gov/pubmed/20354532.
- Subramanian S, Goldstein DP, Parlea L, et al. Second primary malignancy risk in thyroid cancer survivors: a systematic review and meta-analysis. Thyroid 2007;17:1277-88. http://www.ncbi.nlm.nih.gov/pubmed/18020916.
- Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39. http://www.ncbi.nlm.nih.gov/pubmed?term=22158127.
- Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res 2007;168:1-64. http://www.ncbi.nlm.nih.gov/pubmed/17722996.
- World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007. http://www.wcrf.org/cancer_research/cup/second_expert_report.php.
- Hurst R, Hooper L, Norat T, et al. Selenium and prostate cancer: systematic review and meta-analysis. Am J Clin Nutr 2012;96:111-22. http://www.ncbi.nlm.nih.gov/pubmed?term=22648711.
- Dennert G, Zwahlen M, Brinkman M, Vinceti M, Zeegers MP, Horneber M. Selenium for preventing cancer. Cochrane Database Syst Rev 2011:CD005195. http://www.ncbi.nlm.nih.gov/pubmed/21563143.
- Key TJ, Appleby PN, Allen NE, et al. Plasma carotenoids, retinol, and tocopherols and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition study. Am J Clin Nutr 2007;86:672-81. http://www.ncbi.nlm.nih.gov/pubmed/17823432.
- Etminan M, Takkouche B, Caamano-Isorna F. The role of tomato products and lycopene in the prevention of prostate cancer: a meta-analysis of observational studies. Cancer Epidemiol Biomarkers Prev 2004;13:340-5. http://www.ncbi.nlm.nih.gov/pubmed?term=15006906.
- Ilic D, Misso M. Lycopene for the prevention and treatment of benign prostatic hyperplasia and prostate cancer: a systematic review. Maturitas 2012;72:269-76. http://www.ncbi.nlm.nih.gov/pubmed?term=22633187.
- Ilic D, Forbes KM, Hassed C. Lycopene for the prevention of prostate cancer. Cochrane Database Syst Rev 2011:CD008007. http://www.ncbi.nlm.nih.gov/pubmed/22071840.
- Yan L, Spitznagel EL. Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis. Am J Clin Nutr 2009;89:1155-63. http://www.ncbi.nlm.nih.gov/pubmed?term=19211820.
- Hwang YW, Kim SY, Jee SH, Kim YN, Nam CM. Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies. Nutr Cancer 2009;61:598-606. http://www.ncbi.nlm.nih.gov/pubmed?term=19838933.
- Jacobs EJ, Newton CC, Stevens VL, Gapstur SM. A large cohort study of long-term acetaminophen use and prostate cancer incidence. Cancer Epidemiol Biomarkers Prev 2011;20:1322-8. http://www.ncbi.nlm.nih.gov/pubmed/21586623.
- Pottegard A, Friis S, Hallas J. Cancer risk in long-term users of vitamin K antagonists: A population-based case-control study. Int J Cancer 2012. http://www.ncbi.nlm.nih.gov/pubmed/23065946.
- Pengo V, Noventa F, Denas G, et al. Long-term use of vitamin K antagonists and incidence of cancer: a population-based study. Blood 2011;117:1707-9. http://www.ncbi.nlm.nih.gov/pubmed/21127176.
- Tagalakis V, Tamim H, Blostein M, Collet JP, Hanley JA, Kahn SR. Use of warfarin and risk of urogenital cancer: a population-based, nested case-control study. Lancet Oncol 2007;8:395-402. http://www.ncbi.nlm.nih.gov/pubmed/17466896.
- Zhang F, Yang Y, Skrip L, et al. Diabetes mellitus and risk of prostate cancer: an updated meta-analysis based on 12 case-control and 25 cohort studies. Acta Diabetol 2012;49 Suppl 1:235-46. http://www.ncbi.nlm.nih.gov/pubmed/23124624.
- Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 2008;100:170-83. http://www.ncbi.nlm.nih.gov/pubmed/18230794.
- MacInnis RJ, English DR. Body size and composition and prostate cancer risk: systematic review and meta-regression analysis. Cancer Causes Control 2006;17:989-1003. http://www.ncbi.nlm.nih.gov/pubmed/16933050.
- Discacciati A, Orsini N, Wolk A. Body mass index and incidence of localized and advanced prostate cancer--a dose-response meta-analysis of prospective studies. Ann Oncol 2012;23:1665-71. http://www.ncbi.nlm.nih.gov/pubmed/22228452.
- Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila) 2011;4:486-501. http://www.ncbi.nlm.nih.gov/pubmed/21233290.
- Muller DC, Giles GG, Sinclair R, Hopper JL, English DR, Severi G. Age-Dependent Associations between Androgenetic Alopecia and Prostate Cancer Risk. Cancer Epidemiol Biomarkers Prev 2013. http://www.ncbi.nlm.nih.gov/pubmed/23074289.
- Huncharek M, Haddock KS, Reid R, Kupelnick B. Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies. Am J Public Health 2010;100:693-701. http://www.ncbi.nlm.nih.gov/pubmed?term=19608952.
- Lee PN, Hamling J. Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. BMC Med 2009;7:36. http://www.ncbi.nlm.nih.gov/pubmed/19638245.
- Gandini S, Boniol M, Haukka J, et al. Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer 2011;128:1414-24. http://www.ncbi.nlm.nih.gov/pubmed?term=20473927.
- Rota M, Scotti L, Turati F, et al. Alcohol consumption and prostate cancer risk: a meta-analysis of the dose-risk relation. Eur J Cancer Prev 2012;21:350-9. http://www.ncbi.nlm.nih.gov/pubmed?term=22095143.
- Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001;85:1700-5. http://www.ncbi.nlm.nih.gov/pubmed?term=11742491.
- Dennis LK. Meta-analysis for combining relative risks of alcohol consumption and prostate cancer. Prostate 2000;42:56-66. http://www.ncbi.nlm.nih.gov/pubmed?term=10579799.
- Alexander DD, Mink PJ, Cushing CA, Sceurman B. A review and meta-analysis of prospective studies of red and processed meat intake and prostate cancer. Nutr J 2010;9:50. http://www.ncbi.nlm.nih.gov/pubmed?term=21044319.
- Qin X, Cui Y, Shen L, et al. Folic acid supplementation and cancer risk: A meta-analysis of randomized controlled trials. Int J Cancer 2013. http://www.ncbi.nlm.nih.gov/pubmed?term=23338728.
- Collin SM, Metcalfe C, Refsum H, et al. Circulating folate, vitamin B12, homocysteine, vitamin B12 transport proteins, and risk of prostate cancer: a case-control study, systematic review, and meta-analysis. Cancer Epidemiol Biomarkers Prev 2010;19:1632-42. http://www.ncbi.nlm.nih.gov/pubmed/20501771.
- Wien TN, Pike E, Wisloff T, Staff A, Smeland S, Klemp M. Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open 2012;2:e000653. http://www.ncbi.nlm.nih.gov/pubmed/22240654.
- Huncharek M, Muscat J, Kupelnick B. Dairy products, dietary calcium and vitamin D intake as risk factors for prostate cancer: a meta-analysis of 26,769 cases from 45 observational studies. Nutr Cancer 2008;60:421-41. http://www.ncbi.nlm.nih.gov/pubmed/18584476.
- Gao X, LaValley MP, Tucker KL. Prospective studies of dairy product and calcium intakes and prostate cancer risk: a meta-analysis. J Natl Cancer Inst 2005;97:1768-77. http://www.ncbi.nlm.nih.gov/pubmed?term=16333032.
- Wright ME, Bowen P, Virtamo J, Albanes D, Gann PH. Estimated phytanic acid intake and prostate cancer risk: a prospective cohort study. Int J Cancer 2012;131:1396-406.
- Chua ME, Sio MC, Sorongon MC, Dy JS. Relationship of dietary intake of omega-3 and omega-6 Fatty acids with risk of prostate cancer development: a meta-analysis of prospective studies and review of literature. Prostate Cancer 2012;2012:826254. http://www.ncbi.nlm.nih.gov/pubmed/23193480.
- Brouwer IA, Katan MB, Zock PL. Dietary alpha-linolenic acid is associated with reduced risk of fatal coronary heart disease, but increased prostate cancer risk: a meta-analysis. J Nutr 2004;134:919-22. http://www.ncbi.nlm.nih.gov/pubmed/15051847.
- Simon JA, Chen YH, Bent S. The relation of alpha-linolenic acid to the risk of prostate cancer: a systematic review and meta-analysis. Am J Clin Nutr 2009;89:1558S-64S. http://www.ncbi.nlm.nih.gov/pubmed/19321563.
- Platz EA, Till C, Goodman PJ, et al. Men with low serum cholesterol have a lower risk of high-grade prostate cancer in the placebo arm of the prostate cancer prevention trial. Cancer Epidemiol Biomarkers Prev 2009;18:2807-13. http://www.ncbi.nlm.nih.gov/pubmed/19887582.
- Mondul AM, Weinstein SJ, Virtamo J, Albanes D. Serum total and HDL cholesterol and risk of prostate cancer. Cancer Causes Control 2011;22:1545-52. http://www.ncbi.nlm.nih.gov/pubmed/21915616.
- Shafique K, McLoone P, Qureshi K, Leung H, Hart C, Morrison DS. Cholesterol and the risk of grade-specific prostate cancer incidence: evidence from two large prospective cohort studies with up to 37 years' follow up. BMC Cancer 2012;12:25. http://www.ncbi.nlm.nih.gov/pubmed/22260413.
- Jacobs EJ, Stevens VL, Newton CC, Gapstur SM. Plasma total, LDL, and HDL cholesterol and risk of aggressive prostate cancer in the Cancer Prevention Study II Nutrition Cohort. Cancer Causes Control 2012;23:1289-96. http://www.ncbi.nlm.nih.gov/pubmed/22692409.
- Mondul AM, Clipp SL, Helzlsouer KJ, Platz EA. Association between plasma total cholesterol concentration and incident prostate cancer in the CLUE II cohort. Cancer Causes Control 2010;21:61-8. http://www.ncbi.nlm.nih.gov/pubmed/19806465.
- Platz EA, Clinton SK, Giovannucci E. Association between plasma cholesterol and prostate cancer in the PSA era. Int J Cancer 2008;123:1693-8. http://www.ncbi.nlm.nih.gov/pubmed/18646186.
- Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis. Am J Clin Nutr 2010;92:1223-33. http://www.ncbi.nlm.nih.gov/pubmed?term=20844069.
- Zheng J, Yang B, Huang T, Yu Y, Yang J, Li D. Green tea and black tea consumption and prostate cancer risk: an exploratory meta-analysis of observational studies. Nutr Cancer 2011;63:663-72. http://www.ncbi.nlm.nih.gov/pubmed?term=21667398.
- Yu X, Bao Z, Zou J, Dong J. Coffee consumption and risk of cancers: a meta-analysis of cohort studies. BMC Cancer 2011;11:96. http://www.ncbi.nlm.nih.gov/pubmed/21406107.
- Park CH, Myung SK, Kim TY, Seo HG, Jeon YJ, Kim Y. Coffee consumption and risk of prostate cancer: a meta-analysis of epidemiological studies. BJU Int 2010;106:762-9. http://www.ncbi.nlm.nih.gov/pubmed/20590551.
- Julin B, Wolk A, Johansson JE, Andersson SO, Andren O, Akesson A. Dietary cadmium exposure and prostate cancer incidence: a population-based prospective cohort study. Br J Cancer 2012;107:895-900. http://www.ncbi.nlm.nih.gov/pubmed?term=22850555.
- Liu Y, Hu F, Li D, et al. Does physical activity reduce the risk of prostate cancer? A systematic review and meta-analysis. Eur Urol 2011;60:1029-44. http://www.ncbi.nlm.nih.gov/pubmed?term=21802197.
- Mahmud SM, Franco EL, Aprikian AG. Use of nonsteroidal anti-inflammatory drugs and prostate cancer risk: a meta-analysis. Int J Cancer 2010;127:1680-91. http://www.ncbi.nlm.nih.gov/pubmed/20091856.
- Shebl FM, Sakoda LC, Black A, et al. Aspirin but not ibuprofen use is associated with reduced risk of prostate cancer: a PLCO study. Br J Cancer 2012;107:207-14. http://www.ncbi.nlm.nih.gov/pubmed/22722313.
- Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 2011;377:31-41. http://www.ncbi.nlm.nih.gov/pubmed?term=21144578.
- Jafari S, Etminan M, Afshar K. Nonsteroidal anti-inflammatory drugs and prostate cancer: a systematic review of the literature and meta-analysis. Can Urol Assoc J 2009;3:323-30,. http://www.ncbi.nlm.nih.gov/pubmed/19672448.
- Veitonmaki T, Tammela TL, Auvinen A, Murtola TJ. Use of aspirin, but not other non-steroidal anti-inflammatory drugs is associated with decreased prostate cancer risk at the population level. Eur J Cancer 2012. http://www.ncbi.nlm.nih.gov/pubmed/23079475.
- Chang SL, Harshman LC, Presti JC, Jr. Impact of common medications on serum total prostate-specific antigen levels: analysis of the National Health and Nutrition Examination Survey. J Clin Oncol 2010;28:3951-7. http://www.ncbi.nlm.nih.gov/pubmed?term=20679596.
- Dale KM, Coleman CI, Henyan NN, Kluger J, White CM. Statins and cancer risk: a meta-analysis. JAMA 2006;295:74-80. http://www.ncbi.nlm.nih.gov/pubmed/16391219.
- Kuoppala J, Lamminpaa A, Pukkala E. Statins and cancer: A systematic review and meta-analysis. Eur J Cancer 2008;44:2122-32. http://www.ncbi.nlm.nih.gov/pubmed/18707867.
- Bonovas S, Filioussi K, Sitaras NM. Statin use and the risk of prostate cancer: A metaanalysis of 6 randomized clinical trials and 13 observational studies. Int J Cancer 2008;123:899-904. http://www.ncbi.nlm.nih.gov/pubmed/18491405.
- Browning DR, Martin RM. Statins and risk of cancer: a systematic review and metaanalysis. Int J Cancer 2007;120:833-43. http://www.ncbi.nlm.nih.gov/pubmed/17131313.
- Bansal D, Undela K, D'Cruz S, Schifano F. Statin use and risk of prostate cancer: a meta-analysis of observational studies. PLoS One 2012;7:e46691. http://www.ncbi.nlm.nih.gov/pubmed/23049713.
- Dennis LK, Lynch CF, Torner JC. Epidemiologic association between prostatitis and prostate cancer. Urology 2002;60:78-83. http://www.ncbi.nlm.nih.gov/pubmed/12100928.
- Cheng I, Witte JS, Jacobsen SJ, et al. Prostatitis, sexually transmitted diseases, and prostate cancer: the California Men's Health Study. PLoS One 2010;5:e8736. http://www.ncbi.nlm.nih.gov/pubmed/20090948.
- Sutcliffe S, Giovannucci E, De Marzo AM, Leitzmann MF, Willett WC, Platz EA. Gonorrhea, syphilis, clinical prostatitis, and the risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 2006;15:2160-6. http://www.ncbi.nlm.nih.gov/pubmed?term=17119041.
- Buckley BS, Lapitan MC, Simpson CR, Sheikh A. Risk of prostate cancer associated with benign prostate disease: a primary care case-control study. Br J Gen Pract 2011;61:e684-91. http://www.ncbi.nlm.nih.gov/pubmed/22054323.
- Tang LF, Jiang H, Shang XJ, et al. [Vasectomy not associated with prostate cancer: a meta-analysis]. Zhonghua Nan Ke Xue 2009;15:545-50. http://www.ncbi.nlm.nih.gov/pubmed/19593998.
- Dennis LK, Dawson DV, Resnick MI. Vasectomy and the risk of prostate cancer: a meta-analysis examining vasectomy status, age at vasectomy, and time since vasectomy. Prostate Cancer Prostatic Dis 2002;5:193-203. http://www.ncbi.nlm.nih.gov/pubmed/12496981.
- Bernal-Delgado E, Latour-Perez J, Pradas-Arnal F, Gomez-Lopez LI. The association between vasectomy and prostate cancer: a systematic review of the literature. Fertil Steril 1998;70:191-200. http://www.ncbi.nlm.nih.gov/pubmed/9696205.
- Visuri T, Pukkala E, Pulkkinen P, Paavolainen P. Decreased cancer risk in patients who have been operated on with total hip and knee arthroplasty for primary osteoarthrosis: a meta-analysis of 6 Nordic cohorts with 73,000 patients. Acta Orthop Scand 2003;74:351-60. http://www.ncbi.nlm.nih.gov/pubmed/12899558.
- Onega T, Baron J, MacKenzie T. Cancer after total joint arthroplasty: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2006;15:1532-7. http://www.ncbi.nlm.nih.gov/pubmed/16896045.
- Taylor ML, Mainous AG, 3rd, Wells BJ. Prostate cancer and sexually transmitted diseases: a meta-analysis. Fam Med 2005;37:506-12. http://www.ncbi.nlm.nih.gov/pubmed/15988645.
- Dennis LK, Dawson DV. Meta-analysis of measures of sexual activity and prostate cancer. Epidemiology 2002;13:72-9. http://www.ncbi.nlm.nih.gov/pubmed/11805589.
- Huang WY, Hayes R, Pfeiffer R, et al. Sexually transmissible infections and prostate cancer risk. Cancer Epidemiol Biomarkers Prev 2008;17:2374-81. http://www.ncbi.nlm.nih.gov/pubmed/18768506.
- Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009;52:611-22. http://www.ncbi.nlm.nih.gov/pubmed/19770804.
- Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007;370:59-67. http://www.ncbi.nlm.nih.gov/pubmed/17617273.
- Van Maele-Fabry G, Libotte V, Willems J, Lison D. Review and meta-analysis of risk estimates for prostate cancer in pesticide manufacturing workers. Cancer Causes Control 2006;17:353-73. http://www.ncbi.nlm.nih.gov/pubmed/16596288.
- Van Maele-Fabry G, Willems JL. Prostate cancer among pesticide applicators: a meta-analysis. Int Arch Occup Environ Health 2004;77:559-70. http://www.ncbi.nlm.nih.gov/pubmed/15688248.
- Van Maele-Fabry G, Willems JL. Occupation related pesticide exposure and cancer of the prostate: a meta-analysis. Occup Environ Med 2003;60:634-42. http://www.ncbi.nlm.nih.gov/pubmed/12937183.
- Rushton L, Hutchings SJ, Fortunato L, et al. Occupational cancer burden in Great Britain. Br J Cancer 2012;107 Suppl 1. http://www.ncbi.nlm.nih.gov/pubmed/22710676:S3-7.
- Wiren S, Haggstrom C, Ulmer H, et al. Pooled cohort study on height and risk of cancer and cancer death. Cancer Causes Control. 2013 Oct 31.