Call for urgent changes to prostate education

Prostate cancer, a leading cause of cancer death among men, urgently requires new prevention strategies, according to scientists researching the links to genetic susceptibility of the disease.

In a paper in JAMA Network this week, Anna Plym and her colleagues at the Karolinska Institutet in Sweden, and Yiwen Zhang from T. H. Chan School of Public Health at Harvard in the US, report that men at higher genetic risk of prostate cancer had a 3-fold increased risk of an early prostate cancer death.

More than 19,000 men were studied, and a little more than 60% were categorised as being at “higher genetic risk.” Of these, 444 prostate cancer deaths were observed, 107 of which occurred by age 75 years and 337 after age 75 years.

They report: “Compared with men at lower genetic risk, men at higher genetic risk had a 3-fold increased rate of early and a 2-fold increased rate of late prostate cancer death.”

They say there was also a consistent pattern of higher risk among men with an unhealthy lifestyle.

“Based on the detailed lifestyle categorisation, both smoking and a BMI of 30 or greater were associated with an increased rate.” 

They estimated that 36% of the deaths in this group might be preventable through factors associated with a healthy lifestyle.

The authors say this analysis provides evidence for targeting men at increased genetic risk with prevention strategies aimed at reducing premature deaths from prostate cancer. 

Associate Professor Phillip Gregory from the Centre for Cancer Biology at the University of South Australia says it’s an interesting report.

“The study assessed men over a long time period and found that those in the higher risk group had worse outcomes in terms of earlier death from prostate cancer and more total deaths from prostate cancer,” Gregory told Cosmos.

“They used a “lifestyle score” (based on smoking, weight, exercise and diet) to see whether this modified the risk and it seemed to do so only in the “higher genetic risk” group.

“The authors estimate that ~one-third of these “higher genetic risk” men may be able to lower their risk through healthier and modifiable lifestyle factors, although they caution this is an “estimate of what is achievable in terms of prevention had everyone had a healthy lifestyle and adopted behaviours that go along with such a lifestyle.

“The study’s strength relies on the examination of two large cohorts with similar findings between the two, suggesting their findings may be generalisable to the wider population.

“The study uses genetic data from large populations and defines a “risk score” based on 400 genetic variants, previously defined in a recent Nature Genetics article in 2023.

“In theory, if a person has had their DNA genotyped for these markers then their risk score could be calculated, but this isn’t routinely done at present. As the costs for these genetic tests come down they are likely to be introduced into standard practice.”

Prostate cancer and your heritage

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