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Comment Prostate cancer (Score 1) 122 Prostate cancer is the leading cancer diagnosis and the second most common cause of cancer-related death in men in the United States. Worldwide, prostate cancer is the fourth most common cancer in men, with incidence and mortality rates that vary markedly among and within different countries. Since the early 1990s, new screening tests and improved treatments have been associated with dramatic shifts in the incidence, stage at diagnosis, and mortality of this disease. Major advances in molecular biology and epidemiology have provided new insights into the etiology and biology of prostate cancer. These developments promise to transform our understanding of this disease and will likely lead to new and better ways to prevent and treat prostate cancer in the foreseeable future. Worldwide Prostate cancer is the fourth most common male malignancy worldwide. Incidence and mortality rates vary tremendously among countries, similar to the variations seen among distinct ethnic groups in the United States. Incidence and mortality rates are generally higher in Western countries than in developing countries. Scandinavian countries have a particularly high rate of prostate cancer diagnosis and death compared with southern European countries. Prostate cancer mortality, for example, is twice as high in Norway as in Spain (24 per 100,000 compared with 13 per 100,000) (Landis et al, 1998; 1999). Asian countries, notably Japan and China, have some of the lowest prostate cancer incidence and mortality rates in the world. Prostate cancer mortality in Japan between 1992 and 1995 was 4 per 100,000 (Landis et al, 1998; 1999). There are multiple complex causes for the worldwide and ethnic variations in prostate cancer incidence. The two major factors are genetics and environment. Epidemiologic studies show that men of African heritage have a high incidence of prostate cancer across the Americas. The prostate cancer incidence in Jamaica, for example, is estimated at 305 per 100,000 (Glover et al, 1998a; 1998b). Although it is possible that this increased incidence can be attributed to shared environmental risks across nations, it is more likely that Africans have a genetic predisposition to developing clinical prostate cancer. This hypothesis is also supported by a report showing that prostate cancer incidence in Nigerian men is similar to that seen in African American men (Osegbe, 1997). The putative genetic causes for this increased susceptibility to prostate cancer are described later in this chapter. Environment also plays an important role in modulating prostate cancer risk around the world. Japanese and Chinese men in the United States have a higher risk of developing and dying from prostate cancer than do their relatives in Japan and China (Muir et al, 1991; Shimizu et al, 1991). Likewise, prostate cancer incidence and mortality have increased in Japan as the country has become more Westernized (Landis et al, 1998). It is important to note, however, that Asian-American men have a lower prostate cancer incidence than white or African-American men, indicating that genetics still plays an important role in determining prostate cancer predisposition. As in the United States, prostate cancer incidence has increased in many countries since the early 1990s. Although much of this increase, as discussed later, can be correlated with the introduction of widespread PSA testing, some of the increase predates prostate cancer screening. In the southeastern Netherlands, prostate cancer incidence increased from 36 per 100,000 in 1971 to 55 per 100,000 in 1989 (Post et al, 1998; 1999). After PSA was introduced in 1990, incidence increased further to 80 per 100,000. Similar increases were reported in Denmark despite the absence of extensive prostate cancer screening. Incidence increased from 11.5 per 100,000 in 1943 to 30.9 per 100,000 (Brasso et al, 1998; Brasso & Iverson, 1999). These findings suggest that some of the worldwide increase in prostate cancer incidence reflects a true increase in the number of patients with clinical prostate cancer, rather than a simple result of increased detection.

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