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Risk Factors for Prostate Cancer
Last reviewed: 23.04.2024
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[Genetic risk factors for prostate cancer
With prostate cancer (PCa) in close relatives, the risk of developing the disease increases at least twice if two relatives are sick and more - 5-11 times. About 9% of cases of prostate cancer are true hereditary prostate cancer. It is likely if the PCa was in three relatives and more or two relatives under the age of 55 years.
According to autopsies, the prevalence of the disease around the world is approximately the same. At the same time, the incidence varies from country to country: in the United States and Northern Europe it is much higher than in Southeast Asia. However, the Japanese living in Hawaii, the incidence increases, and in people living in California - is close to that of Americans. Judging by these data, certain factors of the environment play a role in the transition from the hidden to the clinically manifested cancer. However, the Japanese are much less likely than Europeans and Americans to detect mutations of the p53 gene. In addition, the mutations of androgen receptors in latent prostate cancer are less common than in clinically expressed diseases.
Given the high prevalence of PCa, it is necessary to study the factors initiating the transformation of latent cancer into clinically significant forms, and the development of measures to prevent this process.
Incorrect lifestyle - the main risk factor for prostate cancer
Perhaps, the excess of animal fats in the niche, the deficiency of vitamin E, selenium, lignans and isoflavones, the protective action of sunlight (enhanced vitamin D formation) are important. The most likely and best studied factor, which increases the risk of prostate cancer, is the consumption of fatty foods and, to a lesser extent, of "red" meat. The effect of smoking is not clearly established, but in long-term and many-smoking men, PCa is more aggressive. According to a study by Giovannucci E. Et al. (1999), the risk of developing cancer in men who smoke more than one pack of cigarettes every day for ten years is 85% higher, and the risk of dying from PCa is 200% more than non-smokers. However, there was no significant difference in rates of morbidity and mortality between the two groups. Hickey et al. (2001) examined possible biological mechanisms that explain the relationship between smoking and PCa: the damaging effect of cadmium contained in tobacco; changes in the hormonal background; immune suppression; mutations of genes (eg, p53). Thus, smoking can be considered a risk factor for prostate cancer and its aggressive course.
At present, there is no data on the effect of alcohol on the development of PCa. It is known that red wine in connection with the content of resveratrol in it has a protective effect on the cells of the prostate gland.
Recently, studies of micro- and macronutrients included in the normal diet have been conducted to find factors that can change or reduce the risk of developing prostate cancer. According to two randomized trials, with daily intake of selenium at a dose of 200 mg and vitamin E by 50 mg, a decrease in the risk of PCa was observed at 52 and 36%, respectively. By 2013, the SELECT (Selenium and Vitamin E Prostate Cancer Prevention Trial) study will be completed that will examine the efficacy of selenium and vitamin E as chemopreventive agents.
Many studies are devoted to the study of the effectiveness of drugs that affect androgen status (inhibitors of 3a-reductase), fat metabolism (statins) and inflammation (non-steroidal anti-inflammatory drugs). Since androgens are involved in the pathogenesis of prostate cancer, 5α-reductase inhibitors can reduce the risk of developing a disease by 25%, but the proportion of low-grade cancer increases. Currently, these drugs can not be recommended for the chemoprophylaxis of prostate cancer. The effect of non-steroidal anti-inflammatory drugs (NSAIDs) and statins on the risk of developing prostate cancer has not been clearly demonstrated, so their widespread use with a chemopreventive goal is also not recommended.
Thus, the most important role in the pathogenesis of prostate cancer is played by hereditary factors, and its development is influenced by environmental factors.