Prostate cancer is a major cause of disease and mortality among men, and each year 1.6 million men are diagnosed with and 366,000 men die of prostate cancer. In this review, we discuss the state of evidence for specific genetic, lifestyle, and dietary factors associated with prostate cancer risk. Given the biological heterogeneity of this cancer, we focus on risk factors for advanced or fatal prostate cancer. First, we provide descriptive epidemiology statistics and patterns for prostate cancer incidence and mortality around the world. This includes discussion of the impact of prostate-specific antigen screening on prostate cancer epidemiology. Next, we summarize evidence for selected risk factors for which there is strong or probable evidence of an association: genetics, obesity and weight change, physical activity, smoking, lycopene and tomatoes, fish, vitamin D and calcium, and statins. Finally, we highlight future directions for prostate cancer epidemiology research.

Background The 2012 US Preventive Services Task Force (USPSTF) recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race/ethnicity remains unclear. Methods The proportion of 40–74 year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (BRFSS; 2012–2018). Odds ratios (ORs) of undergoing screening by race/ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race/ethnicity were estimated using Surveillance, Epidemiology and End Results registry data (2004–2017). Results PSA testing frequencies were 32.3% (95% CI = 31.7 to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3 to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9 to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1 to 21.3%) among Asian/Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity =0.005), driven by a larger decline among NHB men ages 40–54 y. The NHB: NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial/ethnic groups. Conclusions The frequency of prostate cancer screening varies by race/ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB: NHW IRR for localized prostate cancer modestly increased following 2012.

Background Men diagnosed with prostate cancer have increased risk for disease progression, cardiovascular events and impairments in quality of life. This pilot study evaluated the feasibility of a randomized walking group intervention to improve quality of life, circulating biomarkers, and morbidity among men with newly diagnosed prostate cancer. Methods Men were recruited at Örebro University Hospital, Sweden and randomized to an 11-week walking group intervention (n=21) or usual care (n=20). The intervention included weekly 1-hour walking group sessions and maintenance of 10,000 steps/day. Outcomes were changes in body composition, clinical factors, biomarkers of cardiovascular health, and quality of life between baseline and end of study. Analysis of covariance was used to compare outcomes in each group adjusted for baseline values. Results All 41 men randomized completed the 11-week trial. Men assigned to the intervention walked on average 10,644 steps/day, and 92% reported missing two or fewer sessions. Both groups experienced similar weight loss at 11-weeks. Men in the intervention had a significant adjusted mean change in high-density lipoprotein of 0.14 mmol/L (95% CI: 0.01-0.27; p=0.04), and suggestive adjusted mean changes in low-density lipoprotein of -0.22 mmol/L (95% CI: -0.47-0.03; p=0.08) and in systolic blood pressure of -8.5 mm Hg (95% CI: -21.2-4.2; p=0.18), compared to the usual care group. Conclusions A walking group intervention among men with recent diagnosis of prostate cancer is feasible and potentially effective in improving cardiovascular health. A larger randomized trial of longer duration is required to elucidate its potential for improvement in longer-term outcomes.

certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.In this prospective study of physical activity and prostate cancer among 49 160 men, vigorous activity was associated with lower risk of lethal and TMPRSS2:ERG-positive disease. Long-term vigorous activity may be beneficial in prevention of lethal prostate cancer and may involve pathways specific to TMPRSS2:ERG-positive disease.

Background Plant-based diets are associated with multiple health benefits and a favorable environmental impact. For prostate cancer, previous studies suggest a beneficial role of specific plant-based foods (e.g., tomatoes) and a potentially harmful role of specific animal-based foods (e.g., meat, dairy). However, less is known about plant-based dietary patterns. Objective To examine the relationship between Plant-based Diet Indices and prostate cancer risk, including clinically relevant disease. Design This was a prospective cohort study including 47,239 men in the Health Professionals Follow-up Study (1986–2014). Overall and healthful Plant-based Diet Indices were calculated from food frequency questionnaires. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) to examine the risk of incident prostate cancer (total and by clinical category), among men ages < 65 and ≥ 65. Results 6,655 men were diagnosed with prostate cancer over follow-up, including 515 with advanced stage at diagnosis, 956 with lethal disease (metastasis or death) and 806 prostate cancer deaths. Greater overall plant-based consumption was associated with a significantly lower risk of fatal prostate cancer (HR 0.81, 95% CI 0.64,1.01; p-trend = 0.04). In men age < 65, higher Plant-based Diet Index was associated with a lower risk of advanced, lethal and fatal prostate cancer. Moreover, greater consumption of a healthful plant-based diet was associated with lower risks of total (HR 0.84; 95% CI 0.73,0.98; P-trend = 0.046) and lethal prostate cancer (HR 0.56; 95% CI 0.34,0.94; P-trend = 0.03) at age < 65. There were no associations between overall or healthful Plant-based Diet Indices with prostate cancer among men ≥ 65 years. Less than 1% of participants followed a strict vegetarian or vegan diet. Conclusions and Relevance This prospective study provides supportive evidence that greater consumption of healthful plant-based foods is associated with a lower risk of aggressive forms of prostate cancer, with stronger benefit among men age < 65.