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  • Opinion
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Prostate cancer: is it time to expand the research focus to early-life exposures?

Nature Reviews Cancer volume 13, pages 208–518 (2013)Cite this article

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An Erratum to this article was published on 12 April 2013

This article has been updated

Abstract

Although the contribution of lifestyle and environment (non-genetic factors) to prostate carcinogenesis is indicated by international variation in prostate cancer occurrence and migration studies, no conclusive modifiable risk factors have yet been identified. One possible reason for this may be the dearth of epidemiological research on exposures experienced early in life, when the immature prostate may be more susceptible to carcinogenic exposures. In this Opinion article, we summarize the rationale for studying early-life exposures, describe the small body of early-life research and its associated challenges, and point to solutions for future research.

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Figure 1: Prostate development and pathology across the life span.
Figure 2: Meta-analysis of the relationship between height and prostate cancer risk.
Figure 3: The association between early-adulthood BMI and prostate cancer risk.
Figure 4: Bacterial isolates in non-sexually active and sexually active adolescent boys.
Figure 5: Epidemiological analyses of suspected dietary risk factors and prostate cancer.
Figure 6: Future directions for early-life aetiological studies of prostate cancer.

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Change history

  • 12 April 2013

    In Figure 1, parts a and b, the text annotation should have read "No studies of prostate lesions" and "No evidence of prostate lesions", respectively. This has been corrected online.

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Acknowledgements

The authors thank G. L. Andriole, A. M. De Marzo, E. A. Platz and C. G. Sutcliffe for valuable discussion related to this manuscript; P. Humphrey for generous provision of prostate histological images; and A. Ostendorf for assistance preparing figures. This manuscript was funded by the Barnes-Jewish Hospital Foundation. It makes use of data obtained from the Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan. RERF is a private, non-profit foundation funded by the Japanese Ministry of Health, Labour and Welfare and the US Department of Energy through the US National Academy of Sciences. The conclusions in this report are those of the authors and do not necessarily reflect the scientific judgment of RERF or its funding agencies.

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  1. Siobhan Sutcliffe and Graham A. Colditz are at The Division of Public Health Sciences and the Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, Missouri 63110, USA.,

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Case–control studies

Epidemiological studies that compare two groups of individuals: those who have the condition under study (the cases) and those without the condition (the controls). A link between the suspected risk factor and the disease is suggested when the frequency of that risk factor is significantly different between cases and controls.

Cohort studies

Epidemiological studies of people who are divided into those who have or have not been exposed to a suspected risk factor and who are subsequently observed over time for the development of the disease of interest. A link between the suspected risk factor and the disease is indicated when the exposed and unexposed participants have a significantly different frequency of future development of the disease.

Confounding factors

Variables (also known as confounders) that are associated with both an exposure and a disease outcome such that they distort or mask the true effect of exposure in an epidemiological study. For example, alcohol consumption may seem to increase the risk of lung cancer because of confounding by cigarette smoking, a variable that is associated with, but not caused by, alcohol consumption and that is associated with an increased risk of lung cancer.

Correlates

Variables that are related statistically, but not necessarily causally, to another variable. For example, cigarette smoking is a correlate of alcohol consumption.

Ecological evidence

Derived from studies in which groups of people rather than individuals are analysed. Susceptible to ecologic fallacy, whereby the relation observed between variables on a population level may not reflect the relation between variables on an individual level.

Exposures

Variables the causal effects of which are to be estimated. For example, environmental and lifestyle factors, socioeconomic and working conditions, medical treatments and genetic traits.

Markers

Variables (such as height) that may be related causally or non-causally to another variable of interest (such as levels of early-life growth factors). Can be useful for estimating the variable of interest if that variable cannot be measured or assessed directly.

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Sutcliffe, S., Colditz, G. Prostate cancer: is it time to expand the research focus to early-life exposures?. Nat Rev Cancer 13, 208–518 (2013). https://doi.org/10.1038/nrc3434

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