Prostate cancer ranks as the second most prevalent cancer in men and the fifth leading cause of cancer-related mortality among men in 2020. A staggering 1,414,000 new cases of prostate cancer were diagnosed, with 375,304 reported deaths in the same year. Despite these alarming statistics, a global lack of awareness persists, leading to widespread ignorance, misconceptions, and mistrust regarding prostate cancer, ultimately contributing to suboptimal screening practices.

The paper of the month, a scoping review, aims to address three key questions: What are the identifiable risk factors for prostate cancer in the literature? What screening and diagnostic tools are prevalent in the literature? What is the screening uptake for prostate cancer according to the literature?

Examining the literature, familial history and genetics, along with age, emerge as the most accepted risk factors. For example, direct family members with prostate cancer can double the chance of an individual developing prostate cancer. Family history of breast cancer also increases the likelihood of developing the disease due to its genetic makeup.

Age is a significant determinant, with the risk escalating after the age of 40, although most diagnoses occur post-50 due to the indolent nature of early-stage prostate cancer.
Race also emerges as a substantial risk factor, with black, Caribbean, and African American men facing double or triple the risk of developing prostate cancer.

Additionally, diet plays a role in prostate cancer risk, with red meat, high saturated fats, sugars and high sodium consumption increasing the risk. Sedentarity, shift work or management roles and smoking and alcohol consumption are also recognized as notable risk factors. Lastly, exposure to hazards such as benzene, toluene, pesticides, fuels, solvents, radiation, or Agent Orange further elevates the risk of developing prostate cancer.

Secondly, the gold standard for prostate cancer screening and diagnosis involves PSA (Protein-Specific Antigen) screening and DRE (Digital Rectal Examination). PSA consists in a blood-test to assess the levels of body glycoprotein, with elevated levels signaling high risk. However, the potency and accuracy of this screening approach have sparked controversy, raising concerns about potential overdiagnosis and overtreatment. DRE, acknowledged as the primary tool used by healthcare professionals, is performed to observe  the prostate gland for enlargement and abnormalities; it may indicate the necessity for further investigations. DRE is typically performed in the advanced stages of the condition, coinciding with the onset of initial symptoms. Unfortunately, this timing hampers the chance for successful treatment. To validate the diagnoses derived from DRE and PSA, a tissue biopsy is frequently recommended.

Finally, while screening strategies have demonstrated their efficacy, the review underscores a concerning trend: in a study, up to 70.3% of respondents remain unaware of the existence of available screening tests for prostate cancer. Furthermore, another study points out that less than half of Canadian men at the age of 50 have undergone a lifetime PSA screening event. Although factors such as racism, poverty, cultural differences, religious beliefs, and language barriers may contribute to barriers in accessing prostate cancer screening, the study emphasizes an overall lack of knowledge. This deficiency fuels a climate of ignorance, misconceptions, and mistrust, particularly concerning prostate cancer screening.

In conclusion, the authors call for a deeper exploration of evidence concerning risk factors and preventive methods for prostate cancer. Additionally, they urge governments to pinpoint specific needs and challenges within their respective countries, advocating for the development of targeted policies and programs dedicated to prostate care and screening. The authors also emphasize the importance of public education initiatives about prostate cancer. Lastly, they propose that substantial government support could enhance the effectiveness of prostate cancer screening efforts.

We at Lifency support the claim of this review and are proud to assist professionals of men’s health to open the discussion about this taboo subject!

Mumuni, S., Donnell, C. O., & Doody, O. (2023). The risk factors and screening uptake for prostate Cancer : A scoping review. Healthcare, 11(20), 2780.