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Prostate Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Significance

Incidence and Mortality

Prostate cancer is the most common cancer diagnosed in North American men, excluding skin cancers. It is estimated that in 2013, approximately 238,590 new cases and 29,720 prostate cancer-related deaths will occur in the United States.[1] Prostate cancer is now the second leading cause of cancer death in men, exceeded only by lung cancer. It accounts for 28% of all male cancers and 10% of male cancer-related deaths.[1] Age-adjusted incidence rates increased steadily over the past several decades, with particularly dramatic increases associated with the inception of widespread use of prostate-specific antigen (PSA) screening in the late 1980s and early 1990s, followed by a more recent fall in incidence. Age-adjusted mortality rates have recently paralleled incidence rates, with an increase followed by a decrease in the early 1990s.[2] It has been suggested that declines in mortality rates in certain jurisdictions reflect the benefit of PSA screening,[3] but others have noted that these observations may be explained by independent phenomena such as improved treatment effects.

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Regional differences have been observed in prostate cancer incidence and mortality rates and in rates of radical prostatectomy. Until 1989, the increased incidence was most likely the result of increased tumor detection due to increasing rates of transurethral prostatectomy.[4,5] Subsequent increases were most likely the result of widespread use of PSA testing for early detection and screening.[6,7] Variable incidence rates may reflect variability in the intensity of early detection practices across the United States and other jurisdictions. While differences in aggregate mortality by regions of the United States have not been observed, considerable variation in mortality rates between African American and white men are seen.[8,9] (Refer to the Population Observations on Early Detection, Incidence, and Prostate Cancer Mortality section of this summary for more information.)

Risk Factors

Prostate cancer is uncommonly seen in men younger than 50 years; the incidence rises rapidly with each decade thereafter. The incidence rate is higher in African American men than in white men. From 2005 to 2009, the overall age-adjusted incidence rate was 236 per 100,000 for African American men and 146.9 per 100,000 for white men.[10] African American males have a higher mortality from prostate cancer, even after attempts to adjust for access-to-care factors.[11] Men with a family history of prostate cancer are at an increased risk of the disease compared with men without this history.[12,13] Other potential risk factors besides age, race, and family history of prostate cancer include alcohol consumption, vitamin or mineral interactions, and other dietary habits.[14,15,16,17,18] A significant body of evidence suggests that a diet high in fat, especially saturated fats and fats of animal origin, is associated with a higher risk of prostate cancer.[19,20] Other possible dietary influences include selenium, vitamin E, vitamin D, lycopene, and isoflavones. (Refer to the PDQ summary on Prostate Cancer Prevention for more information.) Evidence from a nested case-control study within the Physicians' Health Study,[21] in addition to a case-control study [22] and a retrospective review of screened prostate cancer patients,[23] suggests that higher plasma insulin-like growth factor-I levels may be associated with a higher prostate cancer risk.[24] Not all studies, however, have confirmed this association.[25] The estimated lifetime risk of diagnosis of prostate cancer is about 16.5%,[26] and the lifetime risk of dying from this disease is 2.8%.[27]

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