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Prostate cancer risk factors

The key risk factors for prostate cancer are discussed on this page. Prostate cancer risk is also strongly linked with age and ethnicity

No modifiable factors have been conclusively linked with prostate cancer risk, though many factors have been studied. Epidemiological evidence around prostate cancer is often difficult to interpret: risk factors may vary with prostate cancer aggressiveness;1 use of prostate-specific antigen (PSA) testing may vary with other possible risk factors, perhaps introducing possible detection bias; and PSA levels vary with other possible risk factors, perhaps introducing confounding.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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Prostate cancer risk factors overview

 

The International Agency for Research on Cancer (IARC) evaluates evidence on the carcinogenic risk to humans of a number of exposures including tobacco, alcohol, infections, radiation, occupational exposures, and medications.42 The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) evaluates evidence for other exposures including diet, overweight and obesity, and physical exercise.44 IARC and WCRF/AICR evaluations are the gold standard in cancer epidemiology. Their conclusions about prostate cancer risk factors are shown in Table 4.1.

Table 4.1: IARC and WCRF/AICR Evaluations of Prostate Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
-
  • Androgenic (anabolic) steroids
  • Arsenic (and compounds)
  • Cadmium (and compounds)
  • Working in rubber production
  • Thorium-232 (and decay products)
  • X-radiation, gamma radiation
  • Diets high in calcium
-
  • Foods containing lycopene
  • Foods containing selenium
  • Selenium supplements (200 μg/day)

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Age and ethnicity

Prostate cancer risk is strongly related to age and ethnicity.

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Family history and genetic conditions

Around 5–9% of prostate cancers are linked to genes and family history, it is estimated.19

Family history

Prostate cancer risk is 2.1-2.4 times higher in men whose father has/had the disease, meta-analyses have shown.3-5 Prostate cancer risk is 2.9-3.3 times higher in men whose brother has/had the disease, meta-analyses have shown.3-5 Prostate cancer risk is 1.9 times higher in men with a second-degree relative (grandfather, uncle, nephew, or half-sibling) who has/had the disease, a meta-analysis has shown.4

Prostate cancer risk is higher in men aged under 65 compared with older men, and in men with more than one affected first-degree relative or with an affected relative diagnosed aged younger than 60.4-6

Prostate cancer risk is 19-24% higher in men whose mother has/had breast cancer, cohort studies have shown.6,7 Prostate cancer risk is not associated with breast cancer in a sister.6,7

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Genetic conditions

Prostate cancer risk is up to 5 times higher in men with BRCA2 mutation, a cohort study showed; risk is more than 7 times higher in men aged under 65.8

Prostate cancer risk may be higher in men with BRCA1 mutation, but evidence remains unclear.9,10,147

Prostate cancer risk may be increased with several other genetic variants; research is ongoing.11-18

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Prostate cancer risk is 2.1-4.9 times higher in men with Lynch syndrome, compared with the general population, a meta-analysis and cohort study have shown.136,137

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Endogenous hormones

Insulin-like growth factor-1 (IGF-1)

Prostate cancer risk is 38-83% higher in men with the highest levels of insulin-like growth factor-1 (IGF-1), meta- and pooled analyses have shown.26,27 Prostate cancer risk is not associated with insulin-like growth factor-2 (IGF-2) levels, meta- and pooled analyses have shown.27,28

Prostate cancer risk is generally not associated with insulin-like growth factor binding protein (IGFBP) levels, meta- and pooled analyses have shown; this may vary between IGFBPs.27,28

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Testosterone

Androgenic (anabolic) steroids – which have similar effects to testosterone in the body – are classified by IARC as a probable cause of prostate cancer, based on limited evidence (Table 4.1).42

Prostate cancer treatment can involve use of medicines or surgery to reduce testosterone levels, as prostate tumours rely on testosterone to grow.

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Height

Risk of advanced, aggressive, or fatal prostate cancer is 12% higher per 10cm height increment, a meta-analysis has shown.30 Overall prostate cancer risk is 5% higher per 5cm height increment, a pooled analysis of Nordic data showed.120

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Previous cancer

Prostate cancer risk is higher in men with previous kidney,31-33,145 bladder,33-36,145 lung,40 or thyroid41,145 cancers, or melanoma,33,37-39,146 cohort studies have shown.

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Ionising radiation

Thorium-232 and its decay products, X radiation, and gamma radiation are classified by IARC as probable causes of prostate cancer, based on limited evidence (Table 4.1).42 

Prostate cancer risk is higher in atomic bomb survivors compared with the general population, a cohort study has shown.43

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Diet

Calcium

A high-calcium diet is classified by WCRF/AICR as a probable cause of prostate cancer, based on limited evidence (Table 4.1).44

Prostate cancer risk may be 39% higher in men with the highest calcium intake, versus those with the lowest, a meta-analysis showed;74 however evidence is highly variable.73

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Cadmium

Cadmium and cadmium compounds are classified by IARC as probable causes of prostate cancer, based on limited evidence (Table 4.1).42 Cadmium is found in tobacco smoke, but food is the main exposure source in non-smokers.


Prostate cancer risk is 14% higher in men with the highest dietary cadmium intake, versus those with the lowest, a meta-analysis showed.89

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Medical conditions and treatments

Prostatitis

Prostate cancer risk is 60-80% higher in men with prostatitis (inflammation of the prostate) compared with healthy controls, meta-analyses of case-control studies have shown.102,135 This may reflect increased investigative activity around the time of prostatitis diagnosis or a differential recall of prostatitis between men with and without prostate cancer;135 no association between prostatitis and prostate cancer was found in a cohort study.104

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Vasectomy

Prostate cancer risk is 10% higher in men who have had a vasectomy compared with men who have not, a cohort study has shown.108 Meta-analysis results are inconsistent, and confounding (especially by PSA screening) is possible.106,107

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Occupational exposures

Arsenic (and inorganic arsenic compounds) and working in rubber production are classified by IARC as probable causes of prostate cancer, based on limited evidence (Table 4.1).42

Prostate cancer risk is 13-24% higher in men occupationally exposed to pesticides, compared with the general population, meta-analyses have shown.116-118 

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Overweight and obesity

Prostate cancer death risk, and aggressive prostate cancer risk, is 9-15% higher per 5-unit body mass index (BMI) increment, meta-analyses have shown.59-61 Localised prostate cancer risk is 4-6% lower per 5-unit BMI increment, meta-analyses have shown.59-61 This difference by prostate cancer aggressiveness may reflect difficulty detecting and treating prostate cancer in overweight and obese men.61,133,134

Prostate cancer risk may be 30% higher in men in Europe with metabolic syndrome (characterised by overweight/obesity, ineffective insulin use, diabetes and hypertension), a meta-analysis showed; this may be mainly linked to hypertension and abdominal obesity.149

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Factors shown to decrease or have no effect on prostate cancer risk

Decrease risk

Foods containing lycopene are classified by WCRF/AICR as probably protective against prostate cancer (Table 4.1).44

Prostate cancer risk is probably not associated with dietary lycopene (from tomatoes) intake or blood lycopene levels, meta-analyses have shown;48,49 however the evidence remains insufficient to draw firm conclusions.50

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Foods containing selenium are classified by WCRF/AICR as probably protective against prostate cancer (Table 4.1).44

Prostate cancer risk is 26-71% lower in men with the highest blood/nail sample selenium levels, versus those with the lowest, meta-analyses have shown.45,46

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Selenium supplements (200 μg/day) are classified by WCRF/AICR as probably protective against prostate cancer (Table 4.1).44

Prostate cancer risk is not associated with use of selenium supplements, a meta-analysis has shown.46

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Advanced prostate cancer risk is 65% lower in men with the highest blood levels of total carotenoids, a cohort study showed; however this might reflect reduced likelihood of diagnosis at an early stage.47 Prostate cancer risk is 18% lower in men with the highest intake of carrots, compared with those with the lowest intake, a meta-analysis showed.143

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Prostate cancer risk in Asian populations is 48% lower in men with the highest soy intake versus those with the lowest, meta-analyses have shown; there is no association for other populations.51,52

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Prostate cancer risk is 19% lower in men with the highest physical activity levels versus those with the lowest, a meta-analysis showed; there is no association with recreational physical activity, or in men aged 65+.90

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Prostate cancer risk is 38% lower in men who have used 30+ paracetamol pills per month for at least five years, a cohort study showed.53 The protective effect was limited to aggressive prostate cancer,53 this might reflect increased likelihood of diagnosis at an early stage among paracetamol users – however the reasons for this are unclear.

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Prostate cancer risk is 8-14% lower in aspirin users compared with non-users, meta-analyses have shown, with a stronger effect for longer-term aspirin use and for advanced prostate cancer.91,92 The association between aspirin use and risk of prostate cancer death remains unclear.93

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Prostate cancer risk is 17-31% lower in men with exposure to warfarin, cohort and case-control studies show.54-56

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Prostate cancer risk is 15-28% lower in diabetic men compared with non-diabetic men, meta-analyses have shown.57,121,122

Among diabetics, prostate cancer risk does not vary by treatment type.123-126

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Prostate cancer risk is up to a third lower in men with systemic lupus erythematosus, compared with the general population, meta-analyses have shown.138,139

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No effect

Processed meat, milk and dairy products are classified by WCRF/AICR as possible causes of prostate cancer, based on limited-suggestive evidence.44

Pulses (legumes, including soya), dietary vitamin E, and Alpha-tocopherol are classified by WCRF/AICR as possibly protective against prostate cancer, based on limited-suggestive evidence.44

WCRF/AICR make no judgment on the association between prostate cancer risk and intake of cereals (grains) and their products; dietary fibre; potatoes; non-starchy vegetables; fruits; meat; poultry; fish; eggs; total fat; plant oils; sugar (sucrose); sugary foods and drinks; coffee; tea; alcohol; carbohydrate; protein; vitamin A; retinol; thiamin; riboflavin; niacin; vitamin C; vitamin D; gamma-tocopherol; vitamin supplements; multivitamins; iron; phosphorus; zinc; other carotenoids; physical activity; energy expenditure; vegetarian diets; Seventh-day Adventist diets; body fatness; abdominal fatness; birth weight; or energy intake, due to limited evidence.44

Prostate cancer risk is probably not associated with intake of the following foods and supplements, meta- and pooled analyses or systematic reviews have shown:

  • Blood vitamin D levels.65,152
  • Red and processed meat.66-68
  • Vitamin E and retinol (Vitamin A from animal sources).47
  • Folic acid supplements and blood folate levels,70,71 (though some evidence of risk increase72).
  • Dairy products73 (though some evidence of risk increase).74,75
  • Fish (though may reduced risk of prostate cancer death).85
  • Blood cholesterol levels140 (though conflicting findings79-84).
  • Coffee (though some evidence of risk decrease).127,128,130,150
  • Green tea (though some evidence of risk decrease).86,144,148
  • Black tea.86,144,148
  • Alpha-linolenic acid (an omega-3 fatty acid found in plants).76-78

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Prostate cancer risk is probably not associated with the following behaviours, meta- and pooled analyses or systematic reviews have shown:

  • Alcohol drinking.66-68
  • Tobacco smoking (though some evidence of risk increase).63
  • Smokeless tobacco (though some evidence of risk increase).64

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Prostate cancer risk is probably not associated with the following medical conditions and treatments, meta- and pooled analyses or systematic reviews have shown:

  • Statins (though some evidence of risk decrease).97-101,129
  • Digoxin.131,132
  • Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs).91,92,94-96
  • Knee or hip replacement (some evidence of risk decrease but probably due to detection bias).109,110
  • HIV/AIDS.114,115
  • Sexually transmitted infections (some evidence of risk increase but probably due to recall or detection bias).103,104,111-113,151

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Prostate cancer risk is probably not associated with the following other factors, meta- and pooled analyses or systematic reviews have shown:

  • Blood testosterone, other androgen and oestrogen levels.58
  • Androgenetic alopecia (male pattern baldness) (some evidence of risk increase with vertex pattern baldness).62,141
  • Circadian rhythm disruption e.g. through night shift work (some evidence of risk increase).142

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Updated: 24 June 2014