Risk factors for prostate cancer incidence and progression in the health professionals follow-up study
Article first published online: 20 APR 2007
Copyright © 2007 Wiley-Liss, Inc.
International Journal of Cancer
Volume 121, Issue 7, pages 1571–1578, 1 October 2007
How to Cite
Giovannucci, E., Liu, Y., Platz, E. A., Stampfer, M. J. and Willett, W. C. (2007), Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int. J. Cancer, 121: 1571–1578. doi: 10.1002/ijc.22788
- Issue published online: 24 JUL 2007
- Article first published online: 20 APR 2007
- Manuscript Accepted: 14 MAR 2007
- Manuscript Received: 10 JAN 2007
- National Cancer Institute. Grant Number: CA55075
- National Cancer Institute (Hopkins). Grant Number: CA58236
- prostate cancer;
- risk factors
Risk factors for prostate cancer could differ for various sub-groups, such as for “aggressive” and “non-aggressive” cancers or by grade or stage. Determinants of mortality could differ from those for incidence. Using data from the Health Professionals Follow-Up Study, we re-examined 10 factors (cigarette smoking history, physical activity, BMI, family history of prostate cancer, race, height, total energy consumption, and intakes of calcium, tomato sauce and α-linolenic acid) using multivariable Cox regression in relation to multiple subcategories for prostate cancer risk. These were factors that we previously found to be predictors of prostate cancer incidence or advanced prostate cancer in this cohort, and that have some support in the literature. In this analysis, only 4 factors had a clear statistically significant association with overall incident prostate cancer: African–American race, positive family history, higher tomato sauce intake (inversely) and α-linolenic acid intake. In contrast, for fatal prostate cancer, recent smoking history, taller height, higher BMI, family history, and high intakes of total energy, calcium and α-linolenic acid were associated with a statistically significant increased risk. Higher vigorous physical activity level was associated with lower risk. In relation to these risk factors, advanced stage at diagnosis was a good surrogate for fatal prostate cancer, but high-grade (Gleason ≥ 7 or Gleason ≥ 8) was not. Only for high calcium intake was there a close correspondence for associations among high-grade cancer, advanced and fatal prostate cancer. Tomato sauce (inversely) and α-linolenic acid (positively) intakes were strong predictors of advanced cancer among those with low-grade cancers at diagnosis. Although the proportion of advanced stage cancers was much lower after PSA screening began, risk factors for advanced stage prostate cancers were similar in the pre-PSA and PSA era. The complexity of the clinical and pathologic manifestations of prostate cancer must be considered in the design and interpretation of studies. © 2007 Wiley-Liss, Inc.