Lifestyle and Anthropometric Risk Factors for Prostate Cancer in a Cohort of Iowa Men

The evidence concerning the possible association between physical activity and the risk of prostate cancer is inconsistent and additional data are needed. We examined the association between risk of prostate cancer and physical activity at work and in leisure time in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. In our study, including 127,923 men aged 20-97 years from 8 European countries, 2,458 cases of prostate cancer were identified during 8.5 years of followup. Using the Cox proportional hazards model, we investigated the associations between prostate cancer incidence rate and occupational activity and leisure time activity in terms of participation in sports, cycling, walking and gardening; a metabolic equivalent (MET) score based on weekly time spent on the 4 activities; and a physical activity index. MET hours per week of leisure time activity, higher score in the physical activity index, participation in any of the 4 leisure time activities, and the number of leisure time activities in which the participants were active were not associated with prostate cancer incidence. However, higher level of occupational physical activity was associated with lower risk of advanced stage prostate cancer (p trend 5 0.024). In conclusion, our data support the hypothesis of an inverse association between advanced prostate cancer risk and occupational physical activity, but we found no support for an association between prostate cancer risk and leisure time physical activity. ' 2009 UICC Key words: physical activity; exercise; prostate cancer; cohort Prostate cancer is a leading cause of morbidity and mortality in men, 1 but the causes of prostate cancer are essentially unknown and identification of modifiable risk factors is urgently needed.Physical activity might protect against prostate cancer by lowering the level of testosterone and IGF-1 and improving energy balance, immune function and antioxidative defense systems. 2 However, the epidemiological literature on physical activity and prostate

Section: Discussionsupporting

confidence: 90%

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confidence: 99%

Physical activity and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Johnsen

Tjønneland

Thomsen

et al. 2009

“…This result is Epidemiology consistent with several previous reports. With regard to the association between alcohol and prostate cancer by stage, alcohol consumption increased the risk of advanced or fatal prostate cancer, [17][18][19][20] although a recent prospective US cohort study reported a nonsignificant association between alcohol and advanced cancers and an increased risk of nonadvanced cases. 21 Other studies that showed no association between alcohol and prostate cancer might have been affected by detection bias of screening, which would mask an association if heavy drinkers were less likely to get PSA screening.…”

Section: Discussionmentioning

confidence: 99%

Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: The Japan Public Health Center‐based prospective study

Sawada¹,

Inoue

Iwasaki³

et al. 2013

Although alcohol and smoking have not been established as risk factors for prostate cancer, they are important risk factors for other human cancers and potentially major avoidable factors. Alcohol drinkers and smokers might be less likely to get screening, which might lead to attenuation of the positive association. Here, we investigated the association of alcohol drinking and smoking and prostate cancer according to stage, as well as prostate cancer detected by subjective symptoms, in a large prospective study among Japanese men. The Japan Public Health Center-based prospective study (JPHC study) was established in 1990 for Cohort I and in 1993 for Cohort II. Subjects were 48,218 men aged 40-69 years who completed a questionnaire, which included their alcohol and smoking habits at baseline, and who were followed until the end of 2010. During 16 years of follow-up, 913 men were newly diagnosed with prostate cancer; of whom 248 had advanced cases, 635 were organlocalized and 30 were of an undetermined stage. Alcohol consumption was dose-dependently associated with advanced prostate cancer [nondrinkers: reference, 0-150 g=week: hazard ratio (HR) 5 1.23, 95% confidence interval (CI) 5 0.83-1.82; 150-300 g=week: HR 5 1.51, 95% CI 5 1.04-2.19; 300 g=week: HR 5 1.41, 95% CI 5 0.97-2.05, p for trend 5 0.02]. The positive association was not substantially changed among cancers detected by subjective symptoms. Smoking was inversely associated with prostate cancer among total subjects, but tended to increase the risk of advanced prostate cancer detected by subjective symptoms. In conclusion, abstinence from alcohol and prohibition of smoking might be important factors in the prevention of advanced prostate cancer.Alcohol and smoking are important risk factors for human cancers and potentially major avoidable factors. The report by the World Cancer Research Fund=American Institute for Cancer Research (WCRF=AICR) on nutrition, physical activity and cancer concluded that the data were too limited to determine an association between alcohol and prostate cancer. 1 Further, a recent meta-analysis of 50 case-control and 22 cohort studies concluded that there was no evidence of a material association between alcohol drinking and prostate cancer. 2 However, questions remain about the effects of alcohol use at higher intake. Given that the proportion of heavy drinkers has been increasing for decades in Japan, 3 research in Japan might help answer these unsolved questions. Moreover, the effects of alcohol in different histological grades of prostate cancer are also controversial. It is possible that previous studies were affected by detection bias associated with screening, such as prostate-specific antigen (PSA) screening, which would mask an association if alcohol drinkers were less likely to get screening.With regard to tobacco, the International Agency for Research on Cancer does not consider prostate cancer to be tobacco-related. 4 A recent meta-analysis of 24 prospective cohort studies showed no increased risk of incident pros...

“…[4][5][6][7][8] Several reports implicated obesity as a risk for increased prostate cancer incidence. 4,6,9,10 Others stated that the grade and stage of the disease is affected by BMI, as obese men had more advanced and more aggressive disease. [7][8][9]11,12 Moreover, the rate of prostate-specific antigen (PSA) recurrence after definitive therapy is reportedly higher in obese men.…”

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confidence: 99%

Obesity does not predispose to more aggressive prostate cancer either at biopsy or radical prostatectomy in European men

Gallina

Karakiewicz

Hutterer

et al. 2007

Many investigators suggested that obesity predisposes to adverse prostate cancer characteristics and outcomes. We tested the effect of obesity on the rate of aggressive prostate cancer at either prostate biopsy or radical prostatectomy (RP). Clinical and pathological data were available for 1,814 men. Univariable and multivariable logistic regression models addressed the rate of high grade prostate cancer (HGPCa) at either biopsy or final pathology. Clinical stage, prostate-specific antigen (PSA), percentage of free PSA and prostate volume were the base predictors. All models were fitted with and without body mass index (BMI), which quantified obesity. BMI and its reciprocal (InvBMI) were coded as cubic splines to allow nonlinear effects. Predictive accuracy (PA) was quantified with area under curve estimates, which were subjected to 200 bootstrap resamples to reduce overfit bias. Gains in PA related to the inclusion of BMI were compared using the MantelHaenszel test. HGPCa at biopsy was detected in 562 (31%) and HGPCa at RP pathology was present in 931 (51.3%) men. In either univariable or multivariable models predicting HGPCa at biopsy, BMI or InvBMI failed to respectively reach statistical significance or add to multivariable PA (BMI gain 5 0%, p 5 1.0; InvBMI gain 5 20.2%, p 5 0.9). Conversely, in models predicting HGPCa at RP, BMI and InvBMI represented independent predictors but failed to increase PA (BMI gain 5 0.7%, p 5 0.6; InvBMI gain 5 0.5, p 5 0.7%). Obesity does not predispose to more aggressive prostate cancer at biopsy. Similarly, obesity does not change the ability to identify those who may harbor HGPCa at RP. ' 2007 Wiley-Liss, Inc.