Elizabeth Radke, MPH

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• Elizabeth Radke, MPH
• Faina Linkov, PhD
• University of Pittsburgh Cancer Institute

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Background

• Most commonly diagnosed cancer in American men
• Incidence rate168.9 per 100,000 men
• Third most common cause of cancer death in the
  U.S.
• Mortality rate 33.9 per 100,000 men
• Incidence rates soared in the early to mid 1990s
  when widespread screening for PSA was instituted

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Prostate cancer 2008 (estimate)

• New cases 186,32
• Deaths 28,660

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Survival

• Five year survival rates for local and regional
  stages are essentially 100
• For distant metastases, five year survival is
  only 34

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Demographics

• Median age at prostate cancer diagnosis is 71 in
  whites and 69 in blacks
• Has dropped slightly since introduction of PSA
  screening
• African-Americans have the highest incidence and
  mortality rates
• Incidence and mortality in Asian/Pacific
  Islanders, American Indians, and Hispanics are
  substantially lower than whites
• Incidence and mortality are positively correlated
  with the gross national product

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Prostate Cancer Incidence Rates, by State, 2004
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International Patterns

• Lowest rates are observed in the Far East and on
  the Indian subcontinent
• 2.9 per 100,000 men in China
• Highest rates occur in Western Europe, Australia,
  and North America
• 107.8 and 185.4 per 100,000 white and black men
  in the United States
• Migration studies show that men of Asian heritage
  living in the U.S. are at lower risk than white
  Americans but greater risk than men of similar
  ancestries living in Asia

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Diet Fruits and Vegetables

• Some studies have shown decreased risk of
  prostate cancer with increased intake of
  vegetables, but these findings are inconsistent
• Tomatoes
• Overall data indicate that the intake of tomatoes
  (associated with higher circulating
  concentrations of lycopene) is associated with
  lower risk of prostate cancer
• Brassica or Cruciferous vegetables (Broccoli,
  etc.)
• Small number of studies suggest inverse
  association between eating brassica vegetables
  and prostate cancer

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Diet Protein

• Soy
• Possible decrease in prostate risk with increased
  soy intake
• Red meat and processed meat
• Consumption of red or processed meat has been
  associated with a higher risk of total or
  advanced prostate cancer in some cohort studies
• Fish
• Some studies have shown protective effect of
  eating fish regularly, mostly attributed to
  omega-3 fatty acids

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Diet Other

• Association between fat consumption and prostate
  cancer has been observed in some studies
• Countries with greater per capita milk
  consumption have higher prostate cancer mortality
  rates
• No significant association between smoking and
  alcohol use has been observed

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Other Factors

• Aspirin and Non-Steroidal Anti-Inflammatory
  Agents
• Weak inverse association between regular
  anti-inflammatory use and prostates cancer
• Vasectomy
• Some studies have shown increased risk following
  vasectomy
• Occupational and Environmental Exposures
• Pesticide use
• High electromagnetic field exposure
• STD Infection

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Family History

• Relative risk for having either a father or
  brother with prostate cancer ranges from 2-3
• Risk is higher with increasing number of
  first-degree relatives with disease
• Higher concordance for prostate cancer diagnosis
  between monozygotic than dizygotic twins
• Segregation analyses support an autosomal
  dominant mode of inheritance
• Gene(s) is not yet identified

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Genetic Factors

• Sex Steroid Hormones and Hormone Metabolizing
  Enzymes
• Polymorphisms in Vitamin D Receptor Gene
• Growth Factors
• Infection and Response to Infection
  (Inflammation)
• Sexually transmitted infections
• Prostatitis
• Biotransformation Enzymes

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Screening and Early Detection

• In 2001, 75 of American men aged 50 years or
  older reported that they had every had a PSA
  test, 54 had recently had one
• Efficacy of screening to detect prostate cancer
  at an earlier stage than digital rectal exam has
  been shown
• Sensitivity of PSA test is roughly 67.5-80,
  Specificity is 60-70
• Many false positives
• With PSA concentration over 4 ng/mL, most men
  will receive work-up including prostate biopsy

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Diagnosing Prostate Cancer

• DETECTING PROSTATE CANCER
• PSA
• Kallikrein Tumor Markers
• Digital Rectal Exam
• Biopsy
• STAGING PROSATE CANCER
• The TNM staging system
• Histologic Grading The Gleason Score
• Post-Surgical Evaluation
• Imaging Bone Metastases

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PSA and Prostate Cancer Incidence and
Mortality(U.S. 1975-2000)
PSA Screening
Incidence
Mortality
Source Surveillance, Epidemiology, and End
Results Program, 1975-2000, Division of Cancer
Control and Population Sciences, National Cancer
Institute, 2003.
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What is PSA?

• Prostate-Specific Antigen
• An antigen is something an antibody binds to.
• Member of the Kallikrein protease family.
• Vast majority of PSA in our body is produced by
  secretory prostate epithelial cells.
• Also made in very low amounts in the breast,
  thyroid, and placenta, among others.

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Future Directions

• Etiology
• Role of factors such as obesity
• Genetic factors
• Role of different nutrients
• Role of chronic intraprostatic inflammation
• Excess risk in African-Americans
• Early detection (improve specificity)

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References

• Cancer Epidemiology, 3rd ed. 2006. Oxford
  University Press
• Centers for Disease Control
• American Cancer Society
• Lecture by Donald Vander Griend, PhD, University
  of Chicago Urology Research Laboratory