Autopsy incidence- Incidental prostate cancer is noted in 30% of men in the 6th decade of life and increases significantly through the ninth decade. These data have been reproduced in populations for several areas in the world. Recent studies also suggest that this significant sub-clinical level of prostate cancer is present in men as early as the fourth decade of life.

  • Data from chemoprevention studies: Data from the placebo arm of the Prostate Cancer Prevention Trial has been analyzed to assess prostate cancer prevalence in patients with serum PSA levels below 4.0 ng/mL. In this subset analysis of 2950 patients who uniformly underwent prostate biopsies at the completion of the study, 15.1% of men were found to harbor prostate carcinoma. The prevalence of prostate cancer was 6.6% among men with a PSA level of up to 0.5 ng/mL, 10.1% among those with values of 0.6 to 1.0 ng/mL, 17.0% among those with values of 1.1 to 2.0 ng/mL, 23.9% among those with values of 2.1 to 3.0 ng/mL, and 26.9% among those with values of 3.1 to 4.0 ng/mL. The prevalence of high-grade cancers increased from 12.5 % of cancers associated with a PSA level of 0.5 ng/mL or less to 25.0% of cancers associated with a PSA level of 3.1 to 4.0 ng/mL.
  • Geography- Prostate cancer is more prevalent in higher latitudes. This has been correlated with Vitamin D metabolism and its effect on tissue differentiation.
  • Ethnic Origin- Prostate cancer incidence is unequally distributed among ethnic groups. While it is lowest in native Asians, their risk rises as they migrate from Asia to America, underscoring the importance of potential dietary factors. African American men have a higher rate of cancer than Caucasians and generally present at higher stages of disease. Between 1992 and 1999, the yearly prostate cancer incidence for African American men was 275.3 (per 100,000) compared with 172.9 for Caucasians. 
  • African American men had a higher incidence of metastases at presentation (13%) compared with Caucasian men (8%) and yearly prostate cancer mortality (75.1 per 100,000) exceeding twice that of Caucasian (32.9) patients. 
  • Whether these racial differences in incidence and mortality are due to socioeconomic or biological factors remains controversial. Data from autopsy studies have shown, however, a higher incidence of prostate intraepithelial neoplasia in African American men when compared with Caucasian men, suggesting that biological differences in tumorigenesis may exist. 
  • Data from radical prostatectomy specimens demonstrates a higher incidence of tumors in both the peripheral and transition zones of African American men compared with Caucasian men. 
  • Thus far, a number of racial differences at the molecular level have been described and include variation in the androgen signaling and steroid biosynthesis pathways, insulin-like growth factor signaling axis, hereditary prostate cancer associated genetic loci, as well as loci on chromosomes associated with sporadic prostate cancer, such as the short arm of chromosome 8.


  • Albertson PC, Hanley JA, Gleason DR, Barry MJ: Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 280:975-980, 1998.
  • Cooney, K. A., J. D. McCarthy, et al. (1997). "Prostate cancer susceptibility locus on chromosome 1q: a confirmatory study." J Natl Cancer Inst 89(13): 955-9.
  • Devgan, S. A., B. E. Henderson, et al. (1997). "Genetic variation of 3 beta-hydroxysteroid dehydrogenase type II in three racial/ethnic groups: implications for prostate cancer risk." Prostate 33(1): 9-12.
  • Greenlee, R. T., T. Murray, et al. (2000). "Cancer statistics, 2000." CA Cancer J Clin 50(1): 7-33.
  • Jemal, A., T. Murray, et al. (2003). "Cancer statistics, 2003." CA Cancer J Clin 53(1): 5-26.
  • Kalapurakal, J. A., A. N. Jacob, et al. (1999). "Racial differences in prostate cancer related to loss of heterozygosity on chromosome 8p12-23." Int J Radiat Oncol Biol Phys 45(4): 835-40.
  • Makridakis, N., R. K. Ross, et al. (1997). "A prevalent missense substitution that modulates activity of prostatic steroid 5alpha-reductase." Cancer Res 57(6): 1020-2.
  • Makridakis, N. M., R. K. Ross, et al. (1999). "Association of mis-sense substitution in SRD5A2 gene with prostate cancer in African-American and Hispanic men in Los Angeles, USA." Lancet 354(9183): 975-8.
  • Pettaway, C. A., P. Troncoso, et al. (1998). "Prostate specific antigen and pathological features of prostate cancer in black and white patients: a comparative study based on radical prostatectomy specimens." J Urol 160(2): 437-42.
  • Platz, E. A., M. N. Pollak, et al. (1999). "Racial variation in insulin-like growth factor-1 and binding protein-3 concentrations in middle-aged men." Cancer Epidemiol Biomarkers Prev 8(12): 1107-10.
  • Ross, R. K., L. Bernstein, et al. (1992). "5-alpha-reductase activity and risk of prostate cancer among Japanese and US white and black males." Lancet 339(8798): 887-9.
  • Sakr, W. A., D. J. Grignon, et al. (1995). "Epidemiology of high grade prostatic intraepithelial neoplasia." Pathol Res Pract 191(9): 838-41.
  • Smith, J. R., D. Freije, et al. (1996). "Major susceptibility locus for prostate cancer on chromosome 1 suggested by a genome-wide search." Science 274(5291): 1371-4.
  • Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA Jr. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004 May 27;350(22):2239-46.
  • Tricoli, J. V., D. L. Winter, et al. (1999). "Racial differences in insulin-like growth factor binding protein-3 in men at increased risk of prostate cancer." Urology 54(1): 178-82.
  • Winter, D. L., A. L. Hanlon, et al. (2001). "Plasma levels of IGF-1, IGF-2, and IGFBP-3 in white and African-American men at increased risk of prostate cancer." Urology 58(4): 614-8.
  • Xu, J., D. Meyers, et al. (1998). "Evidence for a prostate cancer susceptibility locus on the X chromosome." Nat Genet 20(2): 175-9.