1. Age
The risk of prostate cancer increases with age.
2. Family History
Men with a family history of prostate cancer in male relatives have a higher risk of developing the disease.
Source
3. Race
African-American men are at higher risk for prostate cancer.
4. Genetic Factors
Over 100 genes have been identified as being associated with prostate cancer. The most common pathogenic genes are:
o BRCA2 (4.5%)
o CHEK2 (2.2%)
o ATM (1.8%)
o BRCA1 (1.1%)
5. Metabolic Syndrome
Conditions like hypertension and a waist circumference ≥102 cm are significantly associated with an increased risk of prostate cancer.
6. Obesity
Studies suggest that obesity may increase the mortality rate associated with prostate cancer.
7. Dietary Factors
While current studies do not establish a causal relationship between specific dietary factors and prostate cancer, the American Urological Association (AUA) still formulates dietary recommendations based on past research. In addition, the European Association of Urology also lists the following research conclusions related to diet and prostate cancer for public reference.
o Alcohol:
Both heavy drinking and complete abstinence have been associated with higher risks of prostate cancer and prostate cancer-specific mortality, with evidence suggesting a correlation with alcohol consumption levels.
o Coffee:
Coffee consumption may reduce the risk of prostate cancer.
o Dairy Products:
High protein intake from dairy has shown a weak correlation with increased prostate cancer risk.
o Fat:
No significant association has been found between long-chain omega-3 polyunsaturated fatty acids and prostate cancer. However, a potential link may exist between fried food consumption and increased prostate cancer risk.
o Tomatoes (Lycopene/Carotenoids):
Some studies suggest that consuming cooked tomatoes and lycopene may have a protective effect against prostate cancer. However, meta-analyses indicate that current evidence is insufficient to recommend lycopene for the prevention or treatment of prostate cancer or benign prostatic hyperplasia.
Source
o Meat:
Meta-analyses show a potential association between the consumption of red meat, total meat, and processed meat with prostate cancer risk.
o Soy (Phytoestrogens: Isoflavones/Coumarins):
A meta-analysis revealed that phytoestrogen intake is significantly associated with a reduced risk of prostate cancer. Soy food consumption has been linked to a lower risk of prostate cancer but is also associated with an increased risk of advanced disease.
o Vitamin D:
A U-shaped relationship has been observed, with both low and high levels of vitamin D associated with an increased risk of prostate cancer, particularly in severe cases.
o Vitamin E/Selenium:
Selenium levels in the blood (primarily in nails, indicating long-term levels) are inversely related to aggressive prostate cancer. However, supplementation with selenium and vitamin E does not appear to impact prostate cancer incidence.
8. Hormonally Active Medications
A. 5-α-Reductase Inhibitors (5-ARIs)
Although 5-α-reductase inhibitors (5-ARIs) appear to have the potential to prevent or delay the progression of prostate cancer (PCa) by reducing the risk of ISUP grade group 1 cancers by 25%, this benefit must be weighed against treatment-related side effects and the potential slight increase in the risk of high-grade prostate cancers (although this does not seem to affect PCa mortality).
Currently, none of the available 5-ARIs are approved by the European Medicines Agency (EMA) for chemoprevention purposes.
B. Testosterone
Men with hypogonadism receiving testosterone supplementation do not have an increased risk of developing PCa. A pooled analysis revealed that men with very low free testosterone levels (lowest 10%) have a below-average risk of PCa.
Furthermore, although evidence is limited, men undergoing expectant management or those who have received radical curative therapy for PCa do not show worse outcomes when receiving testosterone supplementation. This is despite the theoretical concern of increased progression risk following the correction of hypogonadism.
9. Other Potential Risk Factors
A. Inflammatory Bowel Disease (IBD):
Men with IBD have a significantly higher incidence of PCa (ISUP grade ≥ 2).
B. Baldness:
Associated with a higher risk of PCa-specific mortality.
C. Gonorrhea:
Significantly linked to an increased incidence of PCa.
D. Night Shift Work:
A meta-analysis shows that night shift work is associated with an increased risk of PCa.
E. Smoking:
Linked to increased PCa mortality, more aggressive tumor characteristics, and worse prognosis, even after smoking cessation.
F. Cadmium (Cd) Exposure:
A meta-analysis found a positive correlation between occupational exposure to high levels of cadmium and PCa risk (the exact risk magnitude remains unclear due to heterogeneity), whereas non-occupational exposure does not appear to pose the same risk, likely due to lower cadmium concentrations.
G. Human Papillomavirus Type 16 (HPV-16):
Men positive for HPV-16 may have a higher risk of PCa.
H. Plasma Concentration of the Estrogenic Insecticide Chlordecone:
Associated with an increased risk of PCa.
I. Factors Proven Incorrectly Associated with PCa Risk:
These include vasectomy and self-reported acne.
J. Aspirin and NSAID Use:
Conflicting data exists regarding their association with PCa risk and mortality.
K. Ultraviolet Radiation Exposure:
Associated with a reduced risk of PCa.
L. Circumcision:
A review found a small but protective association between circumcision and PCa risk.
M. Ejaculation Frequency:
Higher ejaculation frequency (≥21 times per month versus 4–7 times) is associated with a 20% reduction in PCa risk.
References:
https://uroweb.org/guidelines/prostate-cancer/chapter/epidemiology-and-aetiology
