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Risk factors for prostate cancer

A Oliver Sartor, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


Prostate cancer is the second most common cancer in men worldwide, with an estimated 1,100,000 cases and 307,000 deaths in 2012 [1]. The current lifetime risk of prostate cancer for men living in the United States is estimated to be approximately one in six [2].

Rates of prostate cancer differ over 50-fold among various international populations (figure 1) [3]. However, interpretation of these data is complicated by dramatic changes in the incidence of prostate cancer in the US and other Western countries that have taken place over the past several decades. These changes have been primarily driven by the increased frequency of prostate biopsies performed in asymptomatic men because of an elevated prostate-specific antigen (PSA) level. In the United States, the incidence of prostate cancer dramatically rose in the early 1990s concomitant with the increasing utilization of PSA testing. After an initial peak, incidence rates fell, but they have persisted at a rate nearly twice that recorded in the pre-PSA era. A central argument against routine PSA screening is that many of these cancers, if left undetected, would never have become clinically meaningful during a man's lifetime. (See "Screening for prostate cancer".)

Ascertainment biases constitute an important, but incomplete, explanation for the observed international variations in prostate cancer incidence. Countries that do not utilize PSA testing typically have a much lower rate of prostate cancer compared with those that do. Unless studies control for the number of prostate biopsies performed, it is difficult if not impossible to be definitive in the conclusions.

Of the several known prostate cancer risk factors, the most important are age, ethnicity, genetic factors, and possibly dietary factors. The known risk factors for prostate cancer are reviewed here. Screening for prostate cancer and the clinical manifestations and diagnosis of this disorder are discussed separately. (See "Screening for prostate cancer" and "Clinical presentation and diagnosis of prostate cancer".)

This review will focus on the most common histologic type of prostate malignancy (adenocarcinoma) which comprises over 99 percent of the malignancies which affect this organ. Other histologies include small cell neuroendocrine tumors, sarcomas, and lymphomas, which are rarely encountered. (See "Interpretation of prostate biopsy".)


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