9 Risk Factors For Prostate Cancer Explained – Health Digest

People assigned male at birth (AMAB) are born with a walnut-sized gland called the prostate located under the bladder and in front of the rectum. It is one of the internal parts of the male reproductive system, along with the vas deference, ejaculatory ducts, urethra, seminal vesicles, and bulbourethral gland, and it is responsible for the production of a fluid that makes up semen (via the Cleveland Clinic). Prostate cancer occurs when the cells in charge of making said fluid start to grow uncontrollably. This type of cancer is called adenocarcinoma, and it’s the most common type of prostate cancer. However, other rarer types include small cell carcinomas, transitional cell carcinomas, and sarcomas, per the American Cancer Society (ACS).

Prostate cancer is the second leading type of cancer in people AMAB worldwide (via the World Cancer Research Fund International), and since people now have longer lifespans, by 2040, the number of new prostate cancer cases per year is projected to reach 2.9 million, representing a 107% increase from 1.4 million in 2020 (via The Lancet). However, not all is lost, seeing that understanding prostate cancer risk factors can help you manage them to lower the chance of developing it, though not all factors are preventable. This article explains nine prostate cancer risk factors, ranging from some preventable ones, like lifestyle choices, to other non-preventable ones, such as environmental exposures, biological factors, and genetic predispositions.

Aging is known for being one of the primary risk factors for prostate cancer, and since this is something you cannot control, it qualifies as a non-modifiable or non-preventable factor. According to an article in Clinical Epidemiology, prostate cancer is relatively rare among people AMAB aged 40–44, with only about 9 cases per 100,000 people in that age group. However, the risk increases sharply as they age, reaching about 985 cases per 100,000 people AMAB aged 70–74. This trend shows that the risk of prostate cancer grows significantly with age, representing over a 10,000% risk increase, especially for those over 70. Moreover, the article states that given the trend, some studies suggest that if life expectancy goes beyond 100 years, most people AMAB would develop the cancer.

Per a study published in Aging Clinical and Experimental Research, a potential explanation for why advanced age poses a risk for prostate cancer is that some of the main features of aging, like damage to DNA, cells that stop dividing, and changes in how genes are controlled, are similar to the key features seen in cancer. Thus, since aging and cancer share these biological changes, they can contribute to the cancer’s development as people AMAB get older. In addition, not only is the risk higher with age, but the aggressiveness of the cancer seems to increase as well, with each one-year increase in age raising the chances of being diagnosed with a more aggressive cancer.

You may have heard that some medical conditions run in families. Well, this happens to be just the case for prostate cancer, seeing that people AMAB have a higher chance of being diagnosed with this cancer if a family member has also been diagnosed with it in the past. Not only that, but the risk seems to be impacted by the closeness of the affected relative and their age at diagnosis. For instance, according to a study in the Journal of Clinical Oncology, the risk of prostate cancer can increase up to 3-fold when a first-degree relative (a father or brother) has also been diagnosed with it. Moreover, the risk is even higher if those relatives were younger when they were diagnosed. The same seems to be true for the cancer’s aggressiveness. Per the National Library of Medicine (NLM), having a family history of this cancer increases the risk of death by 60%, which could further increase if the relative were diagnosed before the age of 65.

When a family history of prostate cancer becomes such a determinant risk factor, meaning that it is more common in a family than expected by chance, the cancer is often described as familial prostate cancer (FPC), which the study defines as families with at least two first-degree relatives diagnosed at any age or one first-degree relative plus two second-degree relatives, like a grandfather, uncle, or half-brother, diagnosed regardless of age. When explaining why this happens, a review published in Seminars in Oncology states that while genetic susceptibility is always a strong indicator, shared environmental exposures interacting with DNA can also increase the risk.

Genetic mutations happen when genes within your DNA change, causing them to become over- or under-active. This can happen accidentally, due to environmental stressors, or because the mutation was inherited. Regardless of the cause, these mutations make it easier for cancer cells to grow and thrive (per the ACS). According to a study published in the International Journal of Molecular Sciences, when inherited mutations lead to prostate cancer, it is described as hereditary prostate cancer (HPC), which accounts for up to 15% of prostate cancer diagnoses. Per the study, the most common genetic mutations that lead to this cancer include changes in multiple genes, including BRCA1 and BRCA2, CHEK2, ATM, PALB2, HOXB13, BRP1, NSB1, MSH2, MSH6, MLH1, and PMS2.

Out of all these genes, mutations in BRCA1 and BRCA2 are behind most HPC cases (via the Cleveland Clinic), and per an article published in The Lancet, people AMAB under 65 with a BRCA2 mutation are about seven times more likely to develop prostate cancer than those without it. Interestingly enough, mutations in BRCA1 and BRCA2 genes are the same mutations associated with breast cancer. In fact, a study published in Clinical Cancer Research found that a family history of familial breast cancer (FBC) can increase the risk of prostate cancer by 21%, suggesting that you should also consider your family’s breast cancer history as a potential prostate cancer risk factor. While inherited genetic mutations are non-modifiable risk factors, you could benefit from getting genetic counseling, which might help improve your prostate cancer odds by giving you a chance to act earlier through regular screenings, preventive strategies, or tailored treatment options if needed (via ACS).

Prostate cancer is a hormone-sensitive cancer, and when it comes to the culprits, there are three main suspects associated with an increased risk: estrogen, testosterone, and insulin-like growth factor-1 (IGF-1). Starting with estrogen, a review published in Biomedicines explains that since the cancer relies on male hormones like testosterone to grow, estrogen (a female hormone) used to be largely used as a treatment option to hinder its growth up to the ’70s, when researchers discovered that it might actually lead to prostate cancer development by promoting cancer cell survival and increasing the likelihood of healthy cells becoming cancerous, leading to cancer growth and spread.

As for testosterone, a review published in Therapeutic Advances in Urology shares that there seems to be contradicting evidence on whether it is high or low levels of free testosterone that promote the cancer’s development. For example, some evidence suggests that higher free testosterone levels increase the risk of getting a more aggressive cancer at a younger age (via Oxford Population Health). In contrast, the review proposes that low levels may actually be to blame. Lastly, when it comes to IGF-1, a study published in BMC Cancer explains that besides being a growth-promoting hormone that helps cells grow and stay alive, it also reduces cell death. Therefore, it can raise prostate cancer risk by allowing damaged or abnormal cells to multiply. In fact, for every increase in IGF-1, the risk of getting prostate cancer might go up by 9% (via Oxford Population Health).

Vitamin E is a fat-soluble vitamin naturally present in nuts, seeds, and various vegetable oils, such as wheat germ, sunflower, safflower, and corn oils. It is known for its antioxidant properties, which protect your heart, eye, and brain health from the negative effects of free radical-induced oxidative stress. In fact, antioxidants like vitamin E are praised for their protective effects against chronic diseases, such as cancer, per the National Institutes of Health (NIH). Nevertheless, this might not be the case when it comes to prostate cancer, seeing that, ironically, evidence suggests that a high vitamin E intake might actually increase prostate cancer risk.

According to the NIH, one study determined that a daily intake of 400 International Units (IU) of a vitamin E supplement raised the cancers’ risk by 17% in healthy people AMAB. Nevertheless, it’s important to note that 400 IU of a vitamin E supplement equals 180 milligrams of its active form, or 12 times the recommended amount you should consume to meet the vitamin’s Recommended Dietary Allowance (RDA). In other words, it is unlikely you could consume this much vitamin E from natural sources. While the study didn’t find out why this happened, an article in Scientific Reports shared that, despite being a potent antioxidant, vitamin E can also act as a pro-oxidant in prostate cells, causing cell damage by promoting oxidative stress. In addition, the vitamin seems to boost enzymes that activate cancer-causing compounds, ultimately leading to DNA damage that raises the risk of prostate cancer.

While dairy products are considered nutritionally balanced because they provide the three macronutrients, they are also believed to raise prostate cancer risk due to their hormone and calcium content. For starters, a review in the Asia Pacific Journal of Clinical Nutrition determined that a high milk and dairy product intake was linked to a 10% boost in prostate cancer risk, which could further increase as dairy consumption rises. The review suggests that since commercially manufactured milk products are derived from pregnant cows, they tend to have a significant amount of estrogen, a known cancer-promoting hormone in hormone-sensitive cancers like prostate cancer.

Additionally, both the review and an article in Clinical Epidemiology coincide in that milk products’ calcium content may also be a determining risk factor due to the mineral’s effect on IGF-1 and vitamin D levels. As calcium intake increases, the levels of IGF-1 also tend to increase. In other words, there’s a direct link between how much calcium someone consumes and how much IGF-1 their body produces, and IGF-1 is known to promote prostate cancer cell growth. On the other hand, calcium seems to block the conversion of vitamin D from its inactive form to its active form, consequently hindering the vitamin’s protective effect against prostate cancer. On the bright side, since you can control your dairy product intake, this is considered a modifiable or preventable risk factor, meaning that you can manage it by keeping it to a minimum or avoiding dairy altogether.

Ethnicity can be defined as a set of shared cultural or social identity traits, such as language, traditions, ancestry, religion, or geographic origin, with which someone identifies (via Merriam-Webster). As you might imagine, it is among the non-preventable risk factors for prostate cancer, and people AMAB of African descent appear to face a significantly higher risk (via The Lancet). For example, according to the Surveillance, Epidemiology, and End Results (SEER) prostate cancer incidence rates for 2000-2021, people within this ethnic group have consistently had the highest prostate cancer diagnosis rates compared to those of Hispanic, non-Hispanic White, Asian, and American Indian descent. For instance, in 2021, the annual rate for this group was 218 cases per 100,000 people, while the lowest rate was 71 cases per 100,000 people for non-Hispanic Asians in the same year.

Additionally, according to a review published in the British Journal of Cancer, people AMAB of African ancestry tend to be diagnosed not only with a more aggressive type of prostate cancer but also at a younger age compared to people from other ethnic groups. While there is no definitive known cause for the ethnic variations, the review attributed the differences to genetic factors.

As you probably know, not all chemical products are created equal, and while some might make modern life easier, others are known for their cancer-promoting effects, as is the case with arsenic and Agent Orange. Despite being a natural element present in the environment, arsenic is recognized as a human carcinogen (meaning that it can cause cancer) by the International Agency for Research on Cancer (IARC), per the ACS. Common exposure routes include consuming contaminated food or water. In fact, according to a study in Iowa published in Environmental Research, the risk of being diagnosed with prostate cancer increased in the areas where the drinking water had higher levels of arsenic. Furthermore, arsenic exposure can also be an occupational hazard for people in the metallurgic, agricultural, wood-treating, and glass-manufacturing industries. Per the study, arsenic can damage DNA, leading to mutations that increase the risk of cancerous cell growth.

Regarding Agent Orange, this is another recognized carcinogen by the IARC that was used during the Vietnam War as a powerful herbicide (via the ACS). The site lists skin absorption, ingesting contaminated food or water, and even breathing the herbicide as potential exposure means. According to a study published in Cancer, this chemical was not only associated with a 52% increase in prostate cancer risk among Vietnam-era veterans but also with an earlier cancer diagnosis by up to five years compared to veterans without Agent Orange exposure.

Obesity is a chronic condition characterized by high levels of body fat that can reduce quality of life and increase the risk of numerous health conditions, including prostate cancer (via the World Health Organization). Per a review in The Central European Journal of Urology, obesity-related factors, such as changes in hormone levels (including IGF-1), inflammation, and insulin resistance, may contribute to an environment that supports prostate cancer development. What’s more, according to a review published in Critical Reviews in Oncology/Hematology, people AMAB with obesity also seem to face poorer prostate cancer odds, as it can make prostate cancer harder to treat and manage. For example, it may cause worse side effects from cancer treatments, increase the risk of cancer spread, and raise the chances of the cancer returning after treatment, leading to more health problems and a higher risk of death.

Nevertheless, while the former review determined that a lower body weight was linked to a reduced prostate cancer risk, it states that other studies actually reported the opposite effect, in which people with obesity had a lower cancer risk. The inconsistencies have a lot to do with issues with detecting the disease in people with obesity, which would ultimately cause a prostate cancer underdiagnosis. For example, since obesity increases blood volume, it can dilute the prostate-specific antigen (PSA) in the blood, making it harder to detect cancer through PSA testing. Also, digital rectal exams might be less accurate, making it harder to feel abnormalities in the prostate. Lastly, obesity can lead to a larger prostate, which might make it harder to detect cancer during a biopsy.

Reducing the risk of prostate cancer involves adopting a healthy lifestyle filled with modifiable factors that, instead of worsening your odds, could prevent the development of the disease. For instance, according to an article in Clinical Epidemiology, some factors include making the right dietary choices, exercising, considering anti-inflammatory medications, and maintaining healthy sexual habits. Starting with what you eat, a healthy diet plays a crucial role in lowering prostate cancer risk. Eating more foods like tomatoes (which are high in lycopene), cruciferous vegetables such as broccoli and cauliflower, soy products (rich in isoflavones), and fish with a high omega-3 fatty acid content is considered beneficial.

Moreover, physical activity helps promote a healthy weight, which in turn helps lower inflammation and improves hormone regulation, all of which reduce cancer risk. Additionally, aspirin use, as well as other nonsteroidal anti-inflammatory drugs (NSAIDs), may lower the risk of prostate cancer by reducing inflammation. However, be sure to consult with your healthcare provider before using medications for cancer prevention. Lastly, the article notes that leading a healthy sex life that reduces the chances of getting sexually transmitted diseases (STD) can significantly lower your risk of prostate cancer, while a higher ejaculation frequency, either through safe sex or masturbation, may help clear out potential cancer-causing substances in the prostate, thus promoting prostate health. Still, keep in mind that while these actions can work in your favor, they don’t replace regular screenings and consultations with a health professional for early detection and prevention.