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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 1,618,000 cases and 366,000 deaths in 2015 [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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  1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2016.
  2. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212.
  3. Grönberg H. Prostate cancer epidemiology. Lancet 2003; 361:859.
  4. SEER Cancer Statistics Review, 1973-1999 http://seer.cancer.gov/csr/1973_1999/ (Accessed on February 25, 2011).
  5. Hankey BF, Feuer EJ, Clegg LX, et al. Cancer surveillance series: interpreting trends in prostate cancer--part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst 1999; 91:1017.
  6. Delongchamps NB, Singh A, Haas GP. The role of prevalence in the diagnosis of prostate cancer. Cancer Control 2006; 13:158.
  7. Baquet CR, Horm JW, Gibbs T, Greenwald P. Socioeconomic factors and cancer incidence among blacks and whites. J Natl Cancer Inst 1991; 83:551.
  8. Ingles SA, Coetzee GA, Ross RK, et al. Association of prostate cancer with vitamin D receptor haplotypes in African-Americans. Cancer Res 1998; 58:1620.
  9. Platz EA, Rimm EB, Willett WC, et al. Racial variation in prostate cancer incidence and in hormonal system markers among male health professionals. J Natl Cancer Inst 2000; 92:2009.
  10. Parker PM, Rice KR, Sterbis JR, et al. Prostate cancer in men less than the age of 50: a comparison of race and outcomes. Urology 2011; 78:110.
  11. Hoffman RM, Gilliland FD, Eley JW, et al. Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2001; 93:388.
  12. Powell IJ, Banerjee M, Sakr W, et al. Should African-American men be tested for prostate carcinoma at an earlier age than white men? Cancer 1999; 85:472.
  13. Cross CK, Shultz D, Malkowicz SB, et al. Impact of race on prostate-specific antigen outcome after radical prostatectomy for clinically localized adenocarcinoma of the prostate. J Clin Oncol 2002; 20:2863.
  14. Hamilton RJ, Aronson WJ, Presti JC Jr, et al. Race, biochemical disease recurrence, and prostate-specific antigen doubling time after radical prostatectomy: results from the SEARCH database. Cancer 2007; 110:2202.
  15. Bennett CL, Ferreira MR, Davis TC, et al. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. J Clin Oncol 1998; 16:3101.
  16. Harlan LC, Potosky A, Gilliland FD, et al. Factors associated with initial therapy for clinically localized prostate cancer: prostate cancer outcomes study. J Natl Cancer Inst 2001; 93:1864.
  17. Krupski TL, Kwan L, Afifi AA, Litwin MS. Geographic and socioeconomic variation in the treatment of prostate cancer. J Clin Oncol 2005; 23:7881.
  18. Iselin CE, Box JW, Vollmer RT, et al. Surgical control of clinically localized prostate carcinoma is equivalent in African-American and white males. Cancer 1998; 83:2353.
  19. Eastham JA, Kattan MW. Disease recurrence in black and white men undergoing radical prostatectomy for clinical stage T1-T2 prostate cancer. J Urol 2000; 163:143.
  20. Steinberg GD, Carter BS, Beaty TH, et al. Family history and the risk of prostate cancer. Prostate 1990; 17:337.
  21. Zeegers MP, Jellema A, Ostrer H. Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: a meta-analysis. Cancer 2003; 97:1894.
  22. 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.
  23. Hemminki K, Czene K. Age specific and attributable risks of familial prostate carcinoma from the family-cancer database. Cancer 2002; 95:1346.
  24. Bratt O, Drevin L, Akre O, et al. Family History and Probability of Prostate Cancer, Differentiated by Risk Category: A Nationwide Population-Based Study. J Natl Cancer Inst 2016; 108.
  25. Valeri A, Cormier L, Moineau MP, et al. Targeted screening for prostate cancer in high risk families: early onset is a significant risk factor for disease in first degree relatives. J Urol 2002; 168:483.
  26. Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med 2000; 343:78.
  27. Hemminki K, Ji J, Försti A, et al. Concordance of survival in family members with prostate cancer. J Clin Oncol 2008; 26:1705.
  28. 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.
  29. Freedman ML, Haiman CA, Patterson N, et al. Admixture mapping identifies 8q24 as a prostate cancer risk locus in African-American men. Proc Natl Acad Sci U S A 2006; 103:14068.
  30. Gudmundsson J, Sulem P, Manolescu A, et al. Genome-wide association study identifies a second prostate cancer susceptibility variant at 8q24. Nat Genet 2007; 39:631.
  31. Haiman CA, Patterson N, Freedman ML, et al. Multiple regions within 8q24 independently affect risk for prostate cancer. Nat Genet 2007; 39:638.
  32. Yeager M, Orr N, Hayes RB, et al. Genome-wide association study of prostate cancer identifies a second risk locus at 8q24. Nat Genet 2007; 39:645.
  33. 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.
  34. Eeles RA, Kote-Jarai Z, Giles GG, et al. Multiple newly identified loci associated with prostate cancer susceptibility. Nat Genet 2008; 40:316.
  35. 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.
  36. Gudmundsson J, Sulem P, Steinthorsdottir V, et al. Two variants on chromosome 17 confer prostate cancer risk, and the one in TCF2 protects against type 2 diabetes. Nat Genet 2007; 39:977.
  37. Zheng SL, Sun J, Wiklund F, et al. Cumulative association of five genetic variants with prostate cancer. N Engl J Med 2008; 358:910.
  38. Sun J, Zheng SL, Wiklund F, et al. Evidence for two independent prostate cancer risk-associated loci in the HNF1B gene at 17q12. Nat Genet 2008; 40:1153.
  39. Dong JT. Chromosomal deletions and tumor suppressor genes in prostate cancer. Cancer Metastasis Rev 2001; 20:173.
  40. Chang BL, Liu W, Sun J, et al. Integration of somatic deletion analysis of prostate cancers and germline linkage analysis of prostate cancer families reveals two small consensus regions for prostate cancer genes at 8p. Cancer Res 2007; 67:4098.
  41. Xu J, Dimitrov L, Chang BL, et al. A combined genomewide linkage scan of 1,233 families for prostate cancer-susceptibility genes conducted by the international consortium for prostate cancer genetics. Am J Hum Genet 2005; 77:219.
  42. Zheng SL, Sun J, Wiklund F, et al. Genetic variants and family history predict prostate cancer similar to prostate-specific antigen. Clin Cancer Res 2009; 15:1105.
  43. Pritchard CC, Mateo J, Walsh MF, et al. Inherited DNA-Repair Gene Mutations in Men with Metastatic Prostate Cancer. N Engl J Med 2016; 375:443.
  44. Na R, Zheng SL, Han M, et al. Germline Mutations in ATM and BRCA1/2 Distinguish Risk for Lethal and Indolent Prostate Cancer and are Associated with Early Age at Death. Eur Urol 2016.
  45. Agalliu I, Gern R, Leanza S, Burk RD. Associations of high-grade prostate cancer with BRCA1 and BRCA2 founder mutations. Clin Cancer Res 2009; 15:1112.
  46. Mitra A, Fisher C, Foster CS, et al. Prostate cancer in male BRCA1 and BRCA2 mutation carriers has a more aggressive phenotype. Br J Cancer 2008; 98:502.
  47. Tryggvadóttir L, Vidarsdóttir L, Thorgeirsson T, et al. Prostate cancer progression and survival in BRCA2 mutation carriers. J Natl Cancer Inst 2007; 99:929.
  48. Narod SA, Neuhausen S, Vichodez G, et al. Rapid progression of prostate cancer in men with a BRCA2 mutation. Br J Cancer 2008; 99:371.
  49. Edwards SM, Evans DG, Hope Q, et al. Prostate cancer in BRCA2 germline mutation carriers is associated with poorer prognosis. Br J Cancer 2010; 103:918.
  50. Castro E, Goh C, Olmos D, et al. Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer. J Clin Oncol 2013; 31:1748.
  51. Castro E, Goh C, Leongamornlert D, et al. Effect of BRCA Mutations on Metastatic Relapse and Cause-specific Survival After Radical Treatment for Localised Prostate Cancer. Eur Urol 2015; 68:186.
  52. Bancroft EK, Page EC, Castro E, et al. Targeted prostate cancer screening in BRCA1 and BRCA2 mutation carriers: results from the initial screening round of the IMPACT study. Eur Urol 2014; 66:489.
  53. Genitourinary cancer syndromes. In: ASCO Curriculum: Cancer Genetics and Cancer Predisposition Testing, 2nd, Offitt K, Garber J, Grady M (Eds), ASCO Publishing, Alexandria 2004. p.10.
  54. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  55. Raymond VM, Mukherjee B, Wang F, et al. Elevated risk of prostate cancer among men with Lynch syndrome. J Clin Oncol 2013; 31:1713.
  56. Tischkowitz M, Easton DF, Ball J, et al. Cancer incidence in relatives of British Fanconi Anaemia patients. BMC Cancer 2008; 8:257.
  57. Saunders EJ, Dadaev T, Leongamornlert DA, et al. Gene and pathway level analyses of germline DNA-repair gene variants and prostate cancer susceptibility using the iCOGS-genotyping array. Br J Cancer 2016; 114:945.
  58. Kumar A, Coleman I, Morrissey C, et al. Substantial interindividual and limited intraindividual genomic diversity among tumors from men with metastatic prostate cancer. Nat Med 2016; 22:369.
  59. Ewing CM, Ray AM, Lange EM, et al. Germline mutations in HOXB13 and prostate-cancer risk. N Engl J Med 2012; 366:141.
  60. Schulman CC, Ekane S, Zlotta AR. Nutrition and prostate cancer: evidence or suspicion? Urology 2001; 58:318.
  61. Chan JM, Gann PH, Giovannucci EL. Role of diet in prostate cancer development and progression. J Clin Oncol 2005; 23:8152.
  62. Kolonel LN, Nomura AM, Cooney RV. Dietary fat and prostate cancer: current status. J Natl Cancer Inst 1999; 91:414.
  63. Colli JL, Colli A. International comparisons of prostate cancer mortality rates with dietary practices and sunlight levels. Urol Oncol 2006; 24:184.
  64. Giovannucci E, Rimm EB, Colditz GA, et al. A prospective study of dietary fat and risk of prostate cancer. J Natl Cancer Inst 1993; 85:1571.
  65. Sinha R, Park Y, Graubard BI, et al. Meat and meat-related compounds and risk of prostate cancer in a large prospective cohort study in the United States. Am J Epidemiol 2009; 170:1165.
  66. Gann PH, Hennekens CH, Sacks FM, et al. Prospective study of plasma fatty acids and risk of prostate cancer. J Natl Cancer Inst 1994; 86:281.
  67. Allen NE, Key TJ, Appleby PN, et al. Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition. Br J Cancer 2008; 98:1574.
  68. Cohen JH, Kristal AR, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. J Natl Cancer Inst 2000; 92:61.
  69. Jian L, Du CJ, Lee AH, Binns CW. Do dietary lycopene and other carotenoids protect against prostate cancer? Int J Cancer 2005; 113:1010.
  70. Kirsh VA, Peters U, Mayne ST, et al. Prospective study of fruit and vegetable intake and risk of prostate cancer. J Natl Cancer Inst 2007; 99:1200.
  71. Giovannucci E, Rimm EB, Liu Y, et al. A prospective study of tomato products, lycopene, and prostate cancer risk. J Natl Cancer Inst 2002; 94:391.
  72. Peters U, Leitzmann MF, Chatterjee N, et al. Serum lycopene, other carotenoids, and prostate cancer risk: a nested case-control study in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev 2007; 16:962.
  73. Kristal AR, Till C, Platz EA, et al. Serum lycopene concentration and prostate cancer risk: results from the Prostate Cancer Prevention Trial. Cancer Epidemiol Biomarkers Prev 2011; 20:638.
  74. Kavanaugh CJ, Trumbo PR, Ellwood KC. The U.S. Food and Drug Administration's evidence-based review for qualified health claims: tomatoes, lycopene, and cancer. J Natl Cancer Inst 2007; 99:1074.
  75. Zu K, Mucci L, Rosner BA, et al. Dietary lycopene, angiogenesis, and prostate cancer: a prospective study in the prostate-specific antigen era. J Natl Cancer Inst 2014; 106:djt430.
  76. Kolonel LN, Hankin JH, Whittemore AS, et al. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer Epidemiol Biomarkers Prev 2000; 9:795.
  77. Jacobsen BK, Knutsen SF, Fraser GE. Does high soy milk intake reduce prostate cancer incidence? The Adventist Health Study (United States). Cancer Causes Control 1998; 9:553.
  78. Kurahashi N, Iwasaki M, Inoue M, et al. Plasma isoflavones and subsequent risk of prostate cancer in a nested case-control study: the Japan Public Health Center. J Clin Oncol 2008; 26:5923.
  79. Yan L, Spitznagel EL. Meta-analysis of soy food and risk of prostate cancer in men. Int J Cancer 2005; 117:667.
  80. Brasky TM, Till C, White E, et al. Serum phospholipid fatty acids and prostate cancer risk: results from the prostate cancer prevention trial. Am J Epidemiol 2011; 173:1429.
  81. Brasky TM, Darke AK, Song X, et al. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst 2013; 105:1132.
  82. Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001; 85:1700.
  83. Gong Z, Kristal AR, Schenk JM, et al. Alcohol consumption, finasteride, and prostate cancer risk: results from the Prostate Cancer Prevention Trial. Cancer 2009; 115:3661.
  84. Wilson KM, Kasperzyk JL, Rider JR, et al. Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study. J Natl Cancer Inst 2011; 103:876.
  85. Lawson KA, Wright ME, Subar A, et al. Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study. J Natl Cancer Inst 2007; 99:754.
  86. Stevens VL, McCullough ML, Diver WR, et al. Use of multivitamins and prostate cancer mortality in a large cohort of US men. Cancer Causes Control 2005; 16:643.
  87. Price AJ, Travis RC, Appleby PN, et al. Circulating Folate and Vitamin B12 and Risk of Prostate Cancer: A Collaborative Analysis of Individual Participant Data from Six Cohorts Including 6875 Cases and 8104 Controls. Eur Urol 2016; 70:941.
  88. Figueiredo JC, Grau MV, Haile RW, et al. Folic acid and risk of prostate cancer: results from a randomized clinical trial. J Natl Cancer Inst 2009; 101:432.
  89. Allen NE, Travis RC, Appleby PN, et al. Selenium and Prostate Cancer: Analysis of Individual Participant Data From Fifteen Prospective Studies. J Natl Cancer Inst 2016; 108.
  90. Leitzmann MF, Stampfer MJ, Wu K, et al. Zinc supplement use and risk of prostate cancer. J Natl Cancer Inst 2003; 95:1004.
  91. Zhang Y, Coogan P, Palmer JR, et al. Vitamin and mineral use and risk of prostate cancer: the case-control surveillance study. Cancer Causes Control 2009; 20:691.
  92. Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:203.
  93. Chan JM, Giovannucci E, Andersson SO, et al. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden). Cancer Causes Control 1998; 9:559.
  94. Ma J, Stampfer MJ, Gann PH, et al. Vitamin D receptor polymorphisms, circulating vitamin D metabolites, and risk of prostate cancer in United States physicians. Cancer Epidemiol Biomarkers Prev 1998; 7:385.
  95. 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.
  96. Mitrou PN, Albanes D, Weinstein SJ, et al. A prospective study of dietary calcium, dairy products and prostate cancer risk (Finland). Int J Cancer 2007; 120:2466.
  97. Severi G, English DR, Hopper JL, Giles GG. Re: Prospective studies of dairy product and calcium intakes and prostate cancer risk: a meta-analysis. J Natl Cancer Inst 2006; 98:794.
  98. Koh KA, Sesso HD, Paffenbarger RS Jr, Lee IM. Dairy products, calcium and prostate cancer risk. Br J Cancer 2006; 95:1582.
  99. Schwartz GG, Hulka BS. Is vitamin D deficiency a risk factor for prostate cancer? (Hypothesis). Anticancer Res 1990; 10:1307.
  100. Ahonen MH, Tenkanen L, Teppo L, et al. Prostate cancer risk and prediagnostic serum 25-hydroxyvitamin D levels (Finland). Cancer Causes Control 2000; 11:847.
  101. Tuohimaa P, Tenkanen L, Ahonen M, et al. Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: a longitudinal, nested case-control study in the Nordic countries. Int J Cancer 2004; 108:104.
  102. Mucci LA, Spiegelman D. Vitamin D and prostate cancer risk--a less sunny outlook? J Natl Cancer Inst 2008; 100:759.
  103. Ahn J, Peters U, Albanes D, et al. Serum vitamin D concentration and prostate cancer risk: a nested case-control study. J Natl Cancer Inst 2008; 100:796.
  104. Islami F, Moreira DM, Boffetta P, Freedland SJ. A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. Eur Urol 2014; 66:1054.
  105. Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E. Smoking and prostate cancer survival and recurrence. JAMA 2011; 305:2548.
  106. Warren GW, Kasza KA, Reid ME, et al. Smoking at diagnosis and survival in cancer patients. Int J Cancer 2013; 132:401.
  107. Weinmann S, Shapiro JA, Rybicki BA, et al. Medical history, body size, and cigarette smoking in relation to fatal prostate cancer. Cancer Causes Control 2010; 21:117.
  108. Joshu CE, Mondul AM, Meinhold CL, et al. Cigarette smoking and prostate cancer recurrence after prostatectomy. J Natl Cancer Inst 2011; 103:835.
  109. Endogenous Hormones and Prostate Cancer Collaborative Group, Roddam AW, Allen NE, et al. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 2008; 100:170.
  110. 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.
  111. Hsing AW, Deng J, Sesterhenn IA, et al. Body size and prostate cancer: a population-based case-control study in China. Cancer Epidemiol Biomarkers Prev 2000; 9:1335.
  112. Hsing AW, Chua S Jr, Gao YT, et al. Prostate cancer risk and serum levels of insulin and leptin: a population-based study. J Natl Cancer Inst 2001; 93:783.
  113. Hsing AW, Gao YT, Chua S Jr, et al. Insulin resistance and prostate cancer risk. J Natl Cancer Inst 2003; 95:67.
  114. Albanes D, Weinstein SJ, Wright ME, et al. Serum insulin, glucose, indices of insulin resistance, and risk of prostate cancer. J Natl Cancer Inst 2009; 101:1272.
  115. Hubbard JS, Rohrmann S, Landis PK, et al. Association of prostate cancer risk with insulin, glucose, and anthropometry in the Baltimore longitudinal study of aging. Urology 2004; 63:253.
  116. MacInnis RJ, English DR. Body size and composition and prostate cancer risk: systematic review and meta-regression analysis. Cancer Causes Control 2006; 17:989.
  117. Allott EH, Masko EM, Freedland SJ. Obesity and prostate cancer: weighing the evidence. Eur Urol 2013; 63:800.
  118. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371:569.
  119. Bergström A, Pisani P, Tenet V, et al. Overweight as an avoidable cause of cancer in Europe. Int J Cancer 2001; 91:421.
  120. Bañez LL, Hamilton RJ, Partin AW, et al. Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer. JAMA 2007; 298:2275.
  121. 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.
  122. Parker AS, Thiel DD, Bergstralh E, et al. Obese men have more advanced and more aggressive prostate cancer at time of surgery than non-obese men after adjusting for screening PSA level and age: results from two independent nested case-control studies. Prostate Cancer Prostatic Dis 2013; 16:352.
  123. Giovannucci EL, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med 2005; 165:1005.
  124. Giovannucci EL. Author reply. Arch Intern Med 2005; 1675:2539.
  125. Platz EA, Leitzmann MF, Michaud DS, et al. Interrelation of energy intake, body size, and physical activity with prostate cancer in a large prospective cohort study. Cancer Res 2003; 63:8542.
  126. Dennis LK, Dawson DV. Meta-analysis of measures of sexual activity and prostate cancer. Epidemiology 2002; 13:72.
  127. Dennis LK, Lynch CF, Torner JC. Epidemiologic association between prostatitis and prostate cancer. Urology 2002; 60:78.
  128. Sutcliffe S, Giovannucci E, Alderete JF, et al. Plasma antibodies against Trichomonas vaginalis and subsequent risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:939.
  129. Stark JR, Judson G, Alderete JF, et al. Prospective study of Trichomonas vaginalis infection and prostate cancer incidence and mortality: Physicians' Health Study. J Natl Cancer Inst 2009; 101:1406.
  130. Zafar MB, Terris MK. Prostate cancer detection in veterans with a history of Agent Orange exposure. J Urol 2001; 166:100.
  131. Shah SR, Freedland SJ, Aronson WJ, et al. Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy. BJU Int 2009; 103:1168.
  132. Kane CJ, Im R, Amling CL, et al. Outcomes after radical prostatectomy among men who are candidates for active surveillance: results from the SEARCH database. Urology 2010; 76:695.
  133. Giri VN, Cassidy AE, Beebe-Dimmer J, et al. Association between Agent Orange and prostate cancer: a pilot case-control study. Urology 2004; 63:757.
  134. Institute of Medicine: Veterans and Agent Orange, Update 2000, National Academy Press, Washington DC 1998.
  135. Pavuk M, Michalek JE, Ketchum NS. Prostate cancer in US Air Force veterans of the Vietnam war. J Expo Sci Environ Epidemiol 2006; 16:184.
  136. Chamie K, DeVere White RW, Lee D, et al. Agent Orange exposure, Vietnam War veterans, and the risk of prostate cancer. Cancer 2008; 113:2464.
  137. Multigner L, Ndong JR, Giusti A, et al. Chlordecone exposure and risk of prostate cancer. J Clin Oncol 2010; 28:3457.
  138. Lobaccaro JM, Trousson A. Environmental estrogen exposure during fetal life: a time bomb for prostate cancer. Endocrinology 2014; 155:656.
  139. Prins GS, Hu WY, Shi GB, et al. Bisphenol A promotes human prostate stem-progenitor cell self-renewal and increases in vivo carcinogenesis in human prostate epithelium. Endocrinology 2014; 155:805.
  140. Jacobs EJ, Rodriguez C, Mondul AM, et al. A large cohort study of aspirin and other nonsteroidal anti-inflammatory drugs and prostate cancer incidence. J Natl Cancer Inst 2005; 97:975.
  141. Dasgupta K, Di Cesar D, Ghosn J, et al. Association between nonsteroidal anti-inflammatory drugs and prostate cancer occurrence. Cancer J 2006; 12:130.
  142. Perron L, Bairati I, Moore L, Meyer F. Dosage, duration and timing of nonsteroidal antiinflammatory drug use and risk of prostate cancer. Int J Cancer 2003; 106:409.
  143. Salinas CA, Kwon EM, FitzGerald LM, et al. Use of aspirin and other nonsteroidal antiinflammatory medications in relation to prostate cancer risk. Am J Epidemiol 2010; 172:578.
  144. Coogan PF, Rosenberg L, Palmer JR, et al. Statin use and the risk of breast and prostate cancer. Epidemiology 2002; 13:262.
  145. 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.
  146. Platz EA, Leitzmann MF, Visvanathan K, et al. Statin drugs and risk of advanced prostate cancer. J Natl Cancer Inst 2006; 98:1819.
  147. Farwell WR, D'Avolio LW, Scranton RE, et al. Statins and prostate cancer diagnosis and grade in a veterans population. J Natl Cancer Inst 2011; 103:885.
  148. Yu O, Eberg M, Benayoun S, et al. Use of statins and the risk of death in patients with prostate cancer. J Clin Oncol 2014; 32:5.
  149. Jacobs EJ, Anderson RL, Stevens VL, et al. Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort. J Clin Oncol 2016.
  150. Siddiqui MM, Wilson KM, Epstein MM, et al. Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. J Clin Oncol 2014; 32:3033.
  151. Giles GG, Severi G, English DR, et al. Sexual factors and prostate cancer. BJU Int 2003; 92:211.
  152. Rider JR, Wilson KM, Sinnott JA, et al. Ejaculation frequency and risk of prostate cancer: updated results with an additional decade of follow-up. Eur Urol 2016.
  153. Luscombe CJ, Fryer AA, French ME, et al. Exposure to ultraviolet radiation: association with susceptibility and age at presentation with prostate cancer. Lancet 2001; 358:641.
  154. Bodiwala D, Luscombe CJ, Liu S, et al. Prostate cancer risk and exposure to ultraviolet radiation: further support for the protective effect of sunlight. Cancer Lett 2003; 192:145.
  155. John EM, Dreon DM, Koo J, Schwartz GG. Residential sunlight exposure is associated with a decreased risk of prostate cancer. J Steroid Biochem Mol Biol 2004; 89-90:549.
  156. Tuohimaa P, Pukkala E, Scélo G, et al. Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation. Eur J Cancer 2007; 43:1701.
  157. Myles P, Evans S, Lophatananon A, et al. Diagnostic radiation procedures and risk of prostate cancer. Br J Cancer 2008; 98:1852.
  158. Hoffman KE, Hong TS, Zietman AL, Russell AH. External beam radiation treatment for rectal cancer is associated with a decrease in subsequent prostate cancer diagnosis. Cancer 2008; 112:943.
  159. Birgisson H, Påhlman L, Gunnarsson U, Glimelius B. Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 2005; 23:6126.
  160. Willett CG, Zietman AL, Shipley WU, Coen JJ. The effect of pelvic radiation therapy on serum levels of prostate specific antigen. J Urol 1994; 151:1579.
  161. Zietman AL, Zehr EM, Shipley WU. The long-term effect on PSA values of incidental prostatic irradiation in patients with pelvic malignancies other than prostate cancer. Int J Radiat Oncol Biol Phys 1999; 43:715.
  162. Prasad SM, Eggener SE, Lipsitz SR, et al. Effect of Depression on Diagnosis, Treatment, and Mortality of Men With Clinically Localized Prostate Cancer. J Clin Oncol 2014.
  163. Parekh DJ, Ankerst DP, Higgins BA, et al. External validation of the Prostate Cancer Prevention Trial risk calculator in a screened population. Urology 2006; 68:1152.
  164. Online prostate cancer risk calculator. www.compass.fhcrc.org/edrnnci/bin/calculator/main.asp (Accessed on February 25, 2011).