Family History And The Risk Of Prostate Cancer

In a recent study by Kalish and associates using data from the Massachusetts Male Aging Study (MMAS), covering 1149 men with an average of 8.7 person-years of follow-up, the age-adjusted relative risk of prostate cancer incidence associated with prostate cancer family history was 3.78 [95% confidence interval (CI) 1.96-7.28]. This association was independent of environmental factors, such as smoking, alcohol use, body mass index, physical activity, education, sexually transmitted diseases, diet and hormone levels.17 In addition, several case-control studies identified a familial pattern of prostate cancer. For example, men with one first-degree relative with prostate cancer have a 2.1-2.8-fold greater risk of being diagnosed with prostate cancer compared to men in the same age without a family history. As mentioned before, approximately 9-10% of all diagnosed cases are attributed to familial genetics.10

In the last two decades, researchers targeted different genes, seeking to explain the familial predisposition of prostate cancer. At present, the vast majority of men with clinically significant tumors have no known risk factors (with the exception of gender and age). No shared genetic factor has been identified.

Variation of the enzyme 5a-reductase, which converts testosterone to the more potent metabolite of dihydrotestos-terone, may stabilize the mRNA of the enzyme, resulting in prolonged androgenic stimulation of the prostatic tissue. This stimulation, although not proven, may increase the risk of prostate cancer.

Polymorphisms in exon 1 of the androgen receptor gene have been implicated in prostate cancer risk. Ingles et al. found a positive correlation with a lower number of CAG repeats and a younger age of diagnosis and higher grade and

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