Nursing Research Paper on Prostate Cancer Risk Factors

Prostate Cancer Risk Factors

Abstract

Prostate cancer is presently the most widespread non-skin cancer and a primary cause of cancer death among men across the world (Parsons, Eifler & Han, 2014, p. 130). Prostate cancer incidence varies across demographic groups, with the most common risk factors for the disease being age, race and/or ethnicity, and family history. Furthermore, it is among the most controversial of all the solid malignancies. Therefore, this paper identifies and discusses age, race/ethnicity, and family history as the established or more proven prostate cancer risk factors. It explains why and how prostate cancer incidence varies across age, whereby men are faced with greater risk of developing it. Second, it discusses why prostate cancer incidence varies between racial and ethnic population, in which it has identified genetic factors, environmental exposure risk factors, and factors related to health-seeking behaviors as the leading causes. Finally, the paper discusses how family history regarding prostate cancer increases an individual’s risk in developing the disease, and explains how such a history has been useful in encouraging greater use of screening and investigative procedures at an earlier point in men with prostate cancer history.        

Prostate Cancer Risk Factors

Introduction

            Prostate cancer is a type of cancer that develops in a man’s prostate- a gland responsible for the production of seminal fluid that protects, nourishes, and transports sperm cells. Prostate cancer normally develops slowly and at first remains confined mainly to the prostate glands, in which it cannot cause any serious harm. Although some type of prostate cancer may require minimal or no treatment at all because of their slow growth rate, there exist more aggressive types that can spread quickly, thus call urgent comprehensive treatment as they can cause serious harm. Prostate cancer can be treated successfully if detected early, particularly when it is still enclosed within the prostate gland. Prostate cancer has been found to be the most widespread non-skin cancer and the second major cause of cancer mortality in men across the world, after lung cancer (Na et al., 2013, p. 1). Prostate cancer screening rates have been increasing over the years, with results showing that the disease is more prevalent than it was previously thought. Most importantly, there is a clear indication of varying prevalence of the disease across various demographic groups. For example, prostate cancer prevalence in men has been found to vary with age, race/ethnicity, and family history. Although diet is increasingly being considered a risk factor, much of the research investigating its connection to prostate cancer is, at present largely inconclusive. This implies that at present, it is only age, race/ethnicity, and family history that have been proven beyond reasonable doubt to be the leading prostate cancer risk factors (Bolla & Poppel, 2012). This paper seeks to explore why and how age, race/ethnicity and family history are the most common risk factors for prostate cancer across the world. Age, race/ethnicity, and family history are the established and most common prostate cancer risk factors.

Age

Age has been established to be among the most common prostate cancer risk factors. In fact, a man of any age can possibly get prostate cancer. However, the chances of getting the disease have been found to increase rapidly once a man attains age 40, and begins to decline when men reach their eighties (Held-Warmkessel, 2006, p. 8-9). The reduced prostate cancer rates of acceleration after age 80 is attributed to the reduced tissue renewal and cell division in the later stages of the life cycle. This observation has been widely supported by numerous research studies and documented incidences, which show that men that are of age 65 and above constitute over 65% of all prostate cancers diagnosed in men. For example, in the United States (U.S.), the mean age for prostate cancer diagnosis is 69 years for whites and 66 years for African Americans (Held-Warmkessel, 2006, p. 8-9). This situation is not quite different in Europe, as its mean age for diagnosis lies just above 70 years of age (Bolla & Poppel, 2012, p. 8).

 Age also appears to influence the treatment of prostate cancer. The perception that it is a disease mostly affecting the older men has made younger men more reluctant to undergo cancer screening. Therefore, in most incidences of prostate cancer are detected when the affected men are in their old age. At worse, some even die unaware that they actually had prostate cancer. This fact is supported by statistics from both the US and Europe. For example, the mean age at its diagnosis in the US has been established to be 69, while that of Europe lie just above 70 years of age (Bolla & Poppel, 2012, p. 8). Such facts have resulted in the greatest dilemmas in the prostate cancer diagnostics in the modern times, as it is evident that most men having prostate cancer will die with prostate cancer, and not from it (Bolla & Poppel, 2012, p. 8). Therefore, the perception among males that prostate cancer develops during old age has hampered the treatment of cancer at early stage of development among younger males. Low levels of prostate cancer screening among younger males would significantly increase their chances of developing prostate cancer.   

It is evident that older a man gets, the greater the chances that he will get prostate cancer. Several attempts have been made to establish the scientific explanation of this observable fact. The most convincing explanation is that the higher rates of androgenic stimulation of the prostate among adults in their middle and late stages of life is the major cause of prostate cancer among them (Chung, Isaacs & Simons, 2007. p. 366). As the androgenicity level heightens with age, they tend to directly influence a pool of quite aggressive androgen-drive prostate cancers at its onset in early adulthood. However, prostate cancer’s high incidence in the later years of life is less drive by androgenicity, but more by pathologic processes, for instance, oxidative insults, all in which androgens play a permissive role (Chung, Isaacs & Simons, 2007. p. 364).  

Race/Ethnicity

The prostate cancer prevalence has also been found to vary across various racial/ethnic groups. This observation has been widely supported by research studies indicating its higher incidence among some racial and ethnic groups than others. For instance, in the US, the number of African Americans males having prostate cancer is estimated to be more than twice as that of their white Caucasian male counterparts (Nargund, Raghavan, & Sandler, 2007, p. 52). Conversely, men of the Asian descent have been found to have the lowest prostate cancer incidence between ethnic populations (Bolla & Poppel, 2012, p. 9). The variation of prostate cancer incidences across racial and ethnic populations is attributed to the combination of genetic factors, exposure to environmental risk factors, and the factors related to health seeking behavior (Bolla & Poppel, 2012, p. 9).

The varying levels of androgen across racial and ethnic groups are considered as the most possible explanation for the variation of prostate cancer incidence among men of different racial and ethnic backgrounds. This possible genetic cause has been supported by several studies, which have revealed that African American males tend to have higher levels of hormone testosterone than their white male counterparts. According to Nixon and Gomez (2007), the testosterone level in African Americans is approximately 15% higher than those of their white male counterparts (p. 303). More specifically, the excess risk of developing the disease among the African American is attributed to their higher androgen receptor gene CAG repeat length (Held-Warmkessel, 2006, p. 11).

The different environmental exposures that racial groups are subjected to are also believed to contribute to the varying prostate cancer incidence among the various racial and ethnic groups (Schottenfeld & Fraumeni, 2006, p. 1130). For example, while men of Asian descent that are residing in the Asian continent have been found to have the lowest prostate cancer incidence between the racial/ethnic populations, their prostate cancer incidence have been found to increase remarkably once they migrate to foreign lands, such as the US (Bolla & Poppel, 2012, p. 9). This is an indication that environmental variation under which different racial and ethnic groups reside partly contributes to their levels of prostate cancer vulnerability.

Finally, the variations in prostate cancer incidences between racial and ethnic groups can be attributed to their unique health-seeking behaviors (Fitzpatrick et al., 2004, p. 86). For instance, the higher prevalence rates of the disease in African American males have been closely related to their reluctance in undertaking regularly medical check-ups to monitor or assess their health conditions (Mydlo & Godec, 2003, p. 137). Unlike African American men, the Caucasian males have been found to undergo regular medical examinations, whereby prostate cancer’s early signs can be detected. This early detection thereby encourages early intervention measures in managing the disease, which can eventually result in low prostate cancer incidences amongst the white Caucasian men. Conversely, the African American males have a higher prostate cancer incidence because they have not deeply embraced health-seeking behavior. Such a behavior becomes an obstacle to the detection of prostate cancer during its stage of development, thereby reducing the possibilities of successful early intervention (Mydlo & Godec, 2003, p. 137). These failures in early prostate cancer intervention among black males significantly contribute to the higher prostate cancer prevalence rates among black males. However, blacks diagnosed with later stage prostate cancer disease have been found to have lower survival rates even after undergoing corrective measures as compared with whites faced with similar situation (Nargund, Raghavan, & Sandler, 2007, p. 52). This is a clear indication that blacks have a rather more aggressive prostate cancer phenotype.

Family History

Apart from age and race/ethnicity, family history of prostate cancer is another strongest epidemiologic prostate cancer risk factor. Although studies have for years identified numerous incidences of familial clustering of prostate cancer, it has been established that familial clustering alone does not cause inherited genetic susceptibility as environmental and cultural influences do also aggregate in families (Held-Warmkessel, 2006, p. 11). It has been established that the chances that first-degree relatives of an affected man would be diagnosed with the disease themselves have two to three times higher than distant relatives or those with no family history (Thomas et al., 2012, p. 87-88; Madersbacher, 2011, p. 717). This implies that a man having a father or brother that has been diagnosed with prostate cancer is more than twice likely to get prostate cancer himself (Simon, 2004, p. 349). Such a risk further increases if the cancer was detected in family members at an earlier stage in life, for instance, below 50 years, or if it had affected three or more family members (Simon, 2004, p. 349). Although a family history of the disease increases the risks that first-degree relatively would eventually develop the disease, such a history has proved useful in encouraging greater use of screening and investigative procedures in men with prostate family history (Madersbacher, 2011, p. 718). This has partly contributed to the diagnosis and treatment of prostate cancer at an earlier point in the natural history, thus such early detection of prostate cancer among close family members can be regarded as a potential source of the biasness in the estimation of familial risk.

Conclusion

It is evident that age, race/ethnicity, and family history are the most common prostate cancer risk factors. Men are faced with greater risks of developing prostate cancer as they grow older. The varying prostate cancer incidence between racial and ethnic populations is attributed to the combination of genetic factors, exposure to environmental risk factors, and the factors related to health seeking behavior. Its prevalence is highest among black men and lowest among men of Asian descent. Finally, family history is also among the most common prostate cancer risk factors. Men with a first-degree relative that has been diagnosed with prostate cancer have two to three times likelihood of getting the disease themselves. However, the family history of prostate cancer has proved useful in encouraging greater use of screening and investigative procedures at an earlier point in men with prostate cancer history.            

References

Bolla, M., & Poppel, H. (2012). Management of prostate cancer: A multidisciplinary approach. Berlin: Springer.

Chung, L. W. K., Isaacs, W. B., & Simons, J. W. (2007). Prostate Cancer: Biology, Genetics, and the New Therapeutics. Totowa, NJ: Humana Press.

Fitzpatrick, J. J., Villarruel, A. M., Porter, C. P., & ebrary, Inc. (2004). Eliminating Health Disparities among Racial and Ethnic Minorities in the United States. New York: Springer Publishing Company, Incorporated.

Held-Warmkessel, J. (2006). Contemporary issues in prostate cancer: A nursing perspective. Sudbury, Mass: Jones and Bartlett Publishers.

Madersbacher, S., Alcaraz, A., Emberton, M., Hammerer, P., Ponholzer, A., Schröder, F. H., & Tubaro, A. (2011). The influence of family history on prostate cancer risk: implications for clinical management. BJU International107(5), 716-721. doi:10.1111/j.1464-410X.2010.10024.x

Mydlo, J. H., & Godec, C. J. (2003). Prostate cancer: Science and clinical practice. Amsterdam: Academic Press.

Na, R., Wu, Y., Xu, J., Jiang, H., & Ding, Q. (2013). Age-Specific Prostate Specific Antigen Cutoffs for Guiding Biopsy Decision in Chinese Population. Plos ONE8(6), 1-9. doi:10.1371/journal.pone.0067585

Nargund, V. H., Raghavan, D., & Sandler, H. M. (2007). Urological oncology. London: Springer. 

Nixon, D & Gomez, M. (2007). The prostate health program: a guide to preventing and controlling prostate cancer. New York: Simon & Schuster.   

Schottenfeld, D., & Fraumeni, J. F. (2006). Cancer epidemiology and prevention. Oxford: Oxford University Press.

Simon, H.B. (2004). The harvard medical school guide to men’s health: Lessons from the harvard men’s health Studies. New York: Simon & Schuster.  

Thomas, J. A., Gerber, L. L., Moreira, D. M., Hamilton, R. J., Bañez, L. L., Castro-Santamaria, R. R., & … Freedland, S. J. (2012). Prostate cancer risk in men with prostate and breast cancer family history: results from the REDUCE study (R1). Journal Of Internal Medicine272(1), 85-92.