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Overview & epidemiology

Most common non skin cancer in males.

Up to 1 in 8 men (12.5 %) will be diagnosed in their lifetime.

Up to 1 in 40 men (2.5 %) will die from prostate cancer.

Second leading cause of cancer death in men in Aust (5th worldwide)

 

In Aust:

  • Incidence / number of diagnoses peaked 2009
  • Incidence rates increase with age to a peak at 70 – 74, then decrease
  • There may be slightly worse mortality rates in rural and remote Australians
  • Lower incidence/diagnosis in Indigenous Australians, but perhaps poorer survival

 

Incidental prostate cancer:

  • 20 – 25 % or more at radical cystoprostatectomy
  • 5 – 10 % at TURP
  • Autopsy systematic review – 20 – 40 % aged 50 – 70, to a prevalence of 59 % by 80 year

 

Geographic distribution:

  • Wide variation between areas
  • Highest incidence in Aust/NZ and North America, followed by Western and Northern Europe – age-standardised rates around 100 / 100 000
    • Largely due to PSA testing and ageing populations
  • Incidence much lower in Eastern and South-Central Asia – age-standardised rates 5 – 10 / 100 000
  • Mortality rates vary less, but are higher in populations of African descent and lower in Asia

 

Risk factors:

Both genetics and environment play a role in the development of prostate cancer.

The main definitive proven risk factors for prostate cancer are:

  • Age
  • Family history & genetic predisposition
  • Ethnicity

There are many proposed associations with developing prostate cancer but none have been definitively proven and currently there are no definitive modifiable risk factors.

 

Ethnicity

African-Americans and Jamaicans of African descent have the higher rates of prostate cancer incidence in the world, and at least twice as high mortality.

Thought to be multi-factorial – partly biologically more aggressive, partly social (different screening and treatment patterns)

 

Men with Asian backgrounds who are born in the US have a lower incidence of prostate cancer than white Americans, but a higher incidence compared to men of their background born in Asia

 

Family History

Whilst only 5 – 10 % of prostate cancers are thought to be truly hereditary in nature or caused by high risk inherited factors, there is a definite increase in risk in men with relatives with prostate cancer.

Relative risk increases with number of affected family members, degree of relation, and younger age at diagnosis.

  • First degree relative – 2 x risk
  • 2 x first degree relatives – at least 4 x risk