Prostate Cancer Risk Epidemiology and Genetics. Robert F. Marschke, Jr., M.D. November 2, 2013

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1 Prostate Cancer Risk Epidemiology and Genetics Robert F. Marschke, Jr., M.D. November 2, 2013

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3 PROSTATE CANCER RISK FACTORS Age The risk of prostate cancer rises rapidly after age 50 years

4 PROSTATE CANCER RISK FACTORS Race / Ethnicity Compared to non-hispanic white men, prostate cancer occurs: More often in African-American men Less often in Asian-American and Hispanic/Latino men

5 PROSTATE CANCER RISK FACTORS Nationality / Geography More common in North America, northwestern Europe, Australia, Caribbean islands Less common in Asia, Africa, Central and South America

6 PROSTATE CANCER RISK FACTORS Dietary habits may increase risk: Lots of red meat and/or high-fat dairy products Few fruits and vegetables Very high calcium intake

7 PROSTATE CANCER RISK FACTORS Obesity Most studies have not found obesity linked to a higher risk prostate cancer Some studies suggest a higher risk of aggressive prostate cancer and death due to prostate cancer in obese men

8 PROSTATE CANCER RISK FACTORS Workplace Exposures There is some evidence that firefighters exposures to dust and smoke and other substances may increase risk

9 World Trade Center rescue / recovery workers were exposed to pollutants and carcinogens, and from 2001 to 2008, 20,984 participated in the WTC Health Program 575 cancers were found in 552 individuals with increased relative risk for all cancer sites, especially those highly exposed and exposed to significant amounts of dust The relative risk of prostate cancer was 1.44 (National Institute of Environmental Health Science)

10 PROSTATE CANCER RISK FACTORS Smoking Most studies have not found a link between smoking and the risk of developing prostate cancer Some studies linked smoking to a possible small increase in the risk of death from prostate cancer, a finding that will need to be confirmed

11 PROSTATE CANCER RISK FACTORS Inflammation of the Prostate (Prostatitis) Inflammation is often seen in samples of prostate gland tissue that also contain cancer Inflammation may be linked to an increased risk of prostate cancer This is an active area of research

12 PROSTATE CANCER RISK FACTORS Sexually Transmitted Infections May lead to inflammation of the prostate gland Studies so far have no firm conclusions

13 PROSTATE CANCER RISK FACTORS Vasectomy Most recent studies have not found any increased risk among men who have had this operation Fear of an increased risk of prostate cancer should not be a reason to avoid a vasectomy

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15 1953 James Watson and Francis Crick X-ray diffraction Photo 51 A vague image of DNA

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18 PROSTATE CANCER RISK FACTORS Family History Having a father or brother with prostate cancer more than doubles risk Risk is much higher for men with several affected relatives especially with young ages at the time of diagnosis

19 Relative Risk Family History of Prostate Cancer Father diagnosed at any age 2.35 Brother(s) diagnosed at any age 3.14 Two or more FDRs any age 4.39 FDR = first-degree relative

20 PROSTATE CANCER RISK FACTORS Genetics Few familial prostate cancers have been proven to be inherited (5%) Genetic testing for most of these is not available BRCA1 or BRCA2 mutations (breast and ovarian cancers), account for a small percentage of prostate cancers

21 PROSTATE CANCER RISK FACTORS Genetics Other inherited mutated genes associated with prostate cancer are HPC1 (Hereditary Prostate Cancer Gene 1) and HOXB13 The clinical utility of testing for these mutations has not yet been defined Note: most DNA mutations related to prostate cancer develop during a man's lifetime rather than having been inherited

22 Mitochondria are membrane-enclosed structures in our cells Each mitochondrion has its own DNA (similar to bacteria) Mitochondria and mitochondrial DNA come from the egg only (maternal inheritance) Mitochondrial DNA mutations often present as neurological diseases, but they can also present as other diseases

23 Mitochondrial DNA Mutations May increase the cancer rate to four times that of the general population A retrospective evaluation of 470 patients with mitochondrial disorders showed 65 malignancies In men, prostate cancer was the most common malignancy Josef Finsterer, MD, PhD, Neurology Department, Krankenanstalt Rudolfstiftung, Vienna, Austria. XXI World Congress of Neurology (WCN). Free Papers Session 13. Presented September 23, 2013.

24 Conclusions Prostate Cancer Risk Epidemiology and Genetics Things We Cannot Control Family History / Genetics Race / Ethnicity Age

25 Conclusions Prostate Cancer Risk Epidemiology and Genetics Things We Can Control Our Dedication to Science Nationality / Geography Workplace Exposures Smoking Obesity Diet

26 The End Happy Trails to You! Thank you!