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Causes of prostate cancer

The cause of prostate cancer is not known. 

 

There is evidence for a genetic predisposition for this disease as evidenced by the increased incidence in families with a history of the illness. For example, the risk of an individual whose father or brother has suffered prostate cancer is approximately two-fold higher than the background population and when there are two close relatives three and a half times higher of developing the disease. 

 

Some oncogene testing  is worthwhile in some patients (e.g. BRCA-2), and very interesting predictive testing can now be performed to identify those who, quite apart from any family history of the disease, may be at greater genetic risk of developing the disease (see below). Recently, it has been shown that prostate cancer is associated with chromosomal re-arrangements that bring about the over-expression of members of the ETS family of transcription factors, the most common of these re-arrangements is the fusion of coding sequences of the ERG gene to androgen-(male hormone)-regulated sequences in the promoter of the prostate specific TMPRSS2 gene. Other fusions between other ETS family members and TMPRSS2 and ETS re-arrangements involving other fusion partners (including androgen suppressed and androgen insensitive genes) occur. In the future, the evaluation of these genetic markers may be of diagnostic and prognostic value.

 

Even now, there are genetic predictive tests that may help to forecast the risk of an individual from developing prostate cancer, apart from family history of the disease. Thus the deCode ProCa 8 marker genetic profile of men can identify those individuals (white European males) with a twofold chance of developing the disease. This genetic profiling is now available to well men (the controversy is as to how far this extension to screening programmes should be promoted to the public). 

 

There are also well recognised racial and geographical differences in the incidence of the disease. For example, there is an almost two-fold higher incidence of prostate cancer amongst black Americans than amongst whites. Interestingly, environmental studies demonstrate a higher incidence of prostate cancer occurring over the generations in migrants from a lower risk area to a higher risk one.

 In general, the incidence of the disease is lower in Far East and Asia through the Middle East than in the West.

 

Links of incidence to dietary influences, such a dietary saturated fat intake, has been documented but the link is not strong.

 

Whilst there is some epidemiological evidence for a link between exposure to some pollutants such as heavy metals and chemical fertilisers, any such link is weak.

 

The hypothesised link between incidence and either sexual activity or some venereal diseases (e.g. herpes or cytomegalovirus) is unfounded.  However, there is no doubt that the male hormone: testosterone has some/a lot of influence on the risk of developing the disease (eunuchs do not develop prostate cancer).

 

In general, prostate cancer is a disease of the elderly, although, with PSA screening, the disease is now being detected at earlier ages.


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