Prostate cancer risk factors

Prevention

Preventable cases of prostate cancer are not known as it is not clearly linked to any preventable risk factors

Not well understood

Prostate cancer risk factors have not been conclusively identified, despite substantial research

PSA testing

Prostate cancer risk factors are difficult to interpret because of the use of PSA testing

Prostate cancer is not clearly linked to any preventable risk factors.[1-3]

Prostate Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'convincing' evidence    
'Limited' or probable evidence
  • Androgenic (anabolic) steroids
  • Arsenic and inorganic arsenic compounds
  • Cadmium (and compounds)
  • Malathion
  • Rubber production
  • Thorium-232 and its decay products
  • X-radiation, gamma-radiation
  • Red meat
  • Body fatness[a]
  • Adult attained height
 

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.

a IARC classifies evidence on body fatness for fatal prostate cancer as limited, WCRF/AICR classifies evidence on body fatness for advanced prostate cancer as probable

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 119. Accessed September 2017.
  2. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016 Aug 25;375(8):794-8.
  3. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2016.
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Prostate cancer risk is higher in Black males compared with White males or Asian males.[1]

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Inherited factors explain around 5–9% of prostate cancers, it is estimated.[1] A mix of genetic/biological factors and increased diagnostic activity in affected families may underpin the familial risk. Prostate cancer risk is not associated with prostate cancer in an adoptive parent (supporting a genetic link hypothesis),[2] but it is higher sooner rather than later after diagnosis in a family member, (supporting an increased diagnostic activity hypothesis),[3] cohort studies have shown.

Family history

Prostate cancer risk is 2.1-2.4 times higher in men whose father has/had the disease, meta-analyses have shown.[4-6] Prostate cancer risk is 2.9-3.3 times higher in men whose brother has/had the disease, meta-analyses have shown.[4-6] Prostate cancer risk is 1.9 times higher in men with a second-degree relative (grandfather or uncle, nephew, or half-sibling) who has/had the disease, a meta-analysis has shown.[4]

Familial 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.[5-7]

Prostate cancer risk is 19-24% higher in men whose mother has/had breast cancer, cohort studies have shown.[7,8] Prostate cancer risk is not associated with breast cancer in a sister.[7,8]

BRCA1 and BRCA2

Prostate cancer risk is up to 5 times higher in men with BRCA2 mutation compared with the general population, a cohort study showed.[9] Prostate cancer risk among men under 65 years old is more than 7 times higher in those with BRCA2 mutation compared with the general population, a cohort study showed.[9]
Prostate cancer risk may be higher in men with BRCA1 mutation, but evidence remains unclear.[10-12]

Lynch syndrome

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.[13,14]

References

  1. Hemminki K, Czene K. Age specific and attributable risks of familial prostate carcinoma from the family-cancer database. Cancer 2002;95:1346-53.
  2. Zöller B, Li x, Sundguist J et al. Familial transmission of prostate, breast and colorectal cancer in adoptees is related to cancer in biological but not in adoptive parents: a nationwide family study. Eur J Cancer. 2014 Sept 50(13):2319-27
  3. Lee M, Czene K, Rebora P et al. Patterns of changing cancer risks with time since diagnosis of a sibling. Int J cancer. 2015 Aprl 15;136(8):1948-56.
  4. Bruner DW, Moore D, Parlanti A, et al. Relative risk of prostate cancer for men with affected relatives: systematic review and meta-analysis. Int J Cancer 2003;107:797-803.
  5. Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int 2003;91:789-94.
  6. Kicinski M, Vangronsveld J, Nawrot TS. An epidemiological reappraisal of the familial aggregation of prostate cancer: a meta-analysis. PLoS One 2011;6:e27130.
  7. Hemminki K, Chen B. Familial association of prostate cancer with other cancers in the Swedish Family-Cancer Database. Prostate 2005;65:188-94.
  8. Chen YC, Page JH, Chen R, et al. Family history of prostate and breast cancer and the risk of prostate cancer in the PSA era. Prostate 2008;68:1582-91.
  9. Cancer risks in BRCA2 mutation carriers. The Breast Cancer Linkage Consortium. J Natl Cancer Inst 1999;91:1310-6.
  10. Thompson D, Easton DF. Cancer Incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002;94:1358-65.
  11. 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.
  12. Leongamornlert D, Mahmud N, Tymrakiewicz M, et al. Germline BRCA1 mutations increase prostate cancer risk. Br J Cancer. 2012;106(10):1697-701.
  13. Ryan S, Jenkins MA, Win AK. Risk of Prostate Cancer in Lynch Syndrome: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(3):437-49.
  14. Haraldsdottir S, Hampel H, Wei L, et al. Prostate cancer incidence in males with Lynch syndrome. Genet Med. 2014.
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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.[1,2] Prostate cancer risk is not associated with insulin-like growth factor-2 (IGF-2) levels, meta- and pooled analyses have shown.[2,3]

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.[2,3]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Pesticides

Prostate cancer risk is 13-24% higher in men occupationally exposed to pesticides, compared with the general population, meta-analyses have shown.[2-4]

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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2]

Advanced prostate cancer risk is 9-50% higher per 5-unit body mass index (BMI) increment, meta-analyses of cohort studies have shown.[3,4] This reflects increased likelihood of higher-BMI men being diagnosed at an advanced rather than an early stage, not an increased likelihood of them developing prostate cancer overall.[3,4]

Overweight and obesity may be associated with later-stage diagnosis because hormonal factors in excess body weight promote cancer development, or because excess body weight creates technical difficulties in diagnosis and treatment.[4]

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.[5]

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Prostate cancer risk is lower in men with the following medical conditions or using the following treatments, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Diabetes – 15-28% lower risk[1-3] (no variation by diabetes treatment type[4-8])
  • Systemic lupus erythematosus Open a glossary item – up to a third lower risk (some evidence of no association[9]).[10,11]
  • Human immunodeficiency virus (HIV) – 30-31% lower risk,[12,13] does not appear to be explained by increased PSA testing in HIV-positive men.[14]
  • Parkinson’s disease – 20% lower risk.[15]
  • Paracetamol (aggressive prostate cancer) – 38% lower risk with 30+ pills per month for 5+ years risk (though may reflect increased likelihood of early-stage diagnosis).[16]
  • Aspirin – 8-14% lower risk in users versus non-users, stronger effect for longer-term use and for advanced prostate cancer;[17,18] unclear association between aspirin use and risk of prostate cancer death.[19]
  • Warfarin – 17-31% lower risk in users versus non-users.[20-22]

References

  1. 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.
  2. Xu H, Jiang HW, Ding GX, et al. Diabetes mellitus and prostate cancer risk of different grade or stage: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2013;99(3):241-9.
  3. Xu H1, Mao SH, Ding GX, et al. Diabetes mellitus reduces prostate cancer risk - no function of age at diagnosis or duration of disease. Asian Pac J Cancer Prev. 2013;14(1):441-7.
  4. Chen YB, Chen Q, Wang Z, et al. Insulin therapy and risk of prostate cancer: a systematic review and meta-analysis of observational studies. PLoS One. 2013;8(11):e81594.
  5. Tang X, Yang L, He Z, et al. Insulin glargine and cancer risk in patients with diabetes: a meta-analysis. PLoS One. 2012;7(12):e51814.
  6. Bosetti C, Rosato V, Buniato D, et al. Cancer risk for patients using thiazolidinediones for type 2 diabetes: a meta-analysis. Oncologist. 2013;18(2):148-56.
  7. Soranna D, Scotti L, Zambon A, et al. Cancer risk associated with use of metformin and sulfonylurea in type 2 diabetes: a meta-analysis. Oncologist. 2012;17(6):813-22.
  8. Gandini S, Puntoni M, Heckman-Stoddard BM, et al. Metformin and cancer risk and mortality: a systematic review and meta-analysis taking into account biases and confounders. Cancer Prev Res (Phila) 2014;7(9):867-85.
  9. Cao L, Tong H, Xu G, et al. Systemic lupus erythematous and malignancy risk: a meta-analysis. PLoS One. 2015 Apr 17;10(4):e0122964.
  10. Ni J, Qiu LJ, Hu LF, et al. Lung, liver, prostate, bladder malignancies risk in systemic lupus erythematosus: evidence from a meta-analysis. Lupus. 2014;23(3):284-92.
  11. Huang HB, Jiang SC, Han J, et al. A systematic review of the epidemiological literature on the risk of urological cancers in systemic lupus erythematosus. J Cancer Res Clin Oncol. 2014.
  12. Shiels MS, Cole SR, Kirk GD, et al. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009;52:611-22.
  13. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007;370:59-67.
  14. Marcus JL, Chao CR, Leyden WA, et al. Prostate cancer incidence and prostate-specific antigen testing among HIV-positive and HIV-negative men. J Acquir Immune Defic Syndr 2014;66(5):495-502.
  15. Bajaj A, DriverJAa, Schernhammer ES, et al. Parkinson's disease and cancer risk: a systematic review and meta-analysis. Cancer Causes Control. 2010 May:21(5):697-707
  16. Jacobs EJ, Newton CC, Stevens VL, et al. A large cohort study of long-term acetaminophen use and prostate cancer incidence. Cancer Epidemiol Biomarkers Prev 2011;20:1322-8.
  17. Huang TB, Yan Y, Guo ZF, et al. Aspirin use and the risk of prostate cancer: a meta-analysis of 24 epidemiologic studies. Int Urol Nephrol. 2014 Apr 1.
  18. Liu Y, Chen JQ, Xie L, et al. Effect of aspirin and other non-steroidal anti-inflammatory drugs on prostate cancer incidence and mortality: a systematic review and meta-analysis. BMC Med. 2014 Mar 28;12(1):55.
  19. Rothwell PM, Fowkes FG, Belch JF, et al. 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.
  20. 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.
  21. 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.
  22. Tagalakis V, Tamim H, Blostein M, et al. Use of warfarin and risk of urogenital cancer: a population-based, nested case-control study. Lancet Oncol 2007;8:395-402.
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