Changing demography of prostate cancer in Asia

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Abstract

There has been a recent trend in Asia towards increasing incidence of prostate cancer, with some low-risk regions, such as Japan and Singapore, reporting a more rapid increase than high-risk countries. In this study, age-specific and age-standardised (world) incidence rates and mortality rates for prostate cancer in Asian countries for 1978–1997 were retrieved and compared. The results confirm that the incidence of prostate cancer has risen by 5–118% in the indexed Asian countries. Incidence at centres in Japan rose as much as 102% (Miyagi 6.3–12.7 per 100,000 person-years) whilst the incidence in Singaporean Chinese increased 118% from 6.6 to 14.4 per 100,000 person-years. The lowest incidence rate recorded was in Shanghai, China and the highest rates were in Rizal Province in the Philippines, although still much lower than those in the United States of America (USA) and many European countries. Whilst the absolute value of the increase is not comparable to North American and European populations, the incidence ratio in many Asian centres is similar to that of the high-risk countries. The mortality data for prostate cancer showed a similar rising trend. The increases in age-adjusted mortality rates per 100,000 person-years, adjusted to the world standard, ranged from 50% in Thailand to 260% in Korea. The difference may be partly due to genetic polymorphism in the androgen receptor and androgen metabolism pathway enzymes as well as to dietary or environmental factors. In particular, phytochemicals, such as isoflavonoids and tea polyphenols, which are common in Asian diets showed promising anti-mitotic activity in animal and clinical studies. In conclusion, with gradual Westernisation, many Asian countries may be losing their cultural protective factors and acquiring high-risk ones. A better understanding of how these factors interact to cause prostate cancer through further studies with a multi-ethnic perspective will facilitate appropriate public health strategies to minimise high-risk factors and maintain protective factors and keep prostate cancer at bay.

Introduction

Prostate cancer remains one of the most common cancers afflicting men today. It is the third most common cancer in the world and the most frequently diagnosed male cancer in the United States of America (USA), with a world age-standardised rate of 104 per 100,000 [1]. Prostate cancer rates are highest in Western countries and lowest in Asian countries. With ageing populations and increasing use of prostate-specific antigen (PSA) screening, the incidence of prostate cancer in the high-risk countries has risen sharply in the past decade [2], [3], [4]. In Asia, however, the incidence of prostate cancer is significantly lower and it often plays second fiddle to lung, stomach and colon cancer. It is thus revealing that recent data from Asia have shown a general trend towards increasing incidence of prostate cancer, with some low-risk regions, such as Japan and Singapore, reporting a more rapid increase than some high-risk countries [5]. Understanding the genetic and environmental basis for this difference and the changing demographics of Asian prostate cancer has emerged as an important field of study. Several epidemiological studies involving multi-disciplinary and multi-centre collaboration to investigate suspected environmental factors for prostate cancer are ongoing. This review critically examines available data regarding changing epidemiological trends in Asian prostate cancer and discusses the possible reasons behind these trends.

Section snippets

Material and methods

Age-specific and age-standardised (world) incidence rates per 100,000 man-years for prostate cancer over a 20-year period (1978–1997) in Asian countries were retrieved from the four volumes (V–VIII) of Cancer Incidence in Five Continents, published by the International Agency for Research on Cancer (IARC), covering the periods 1978–1982, 1983–1987, 1988–1992 and 1993–1997 [6], [7], [8], [9]. These data were derived from contributions from various cancer registries over the years. The criteria

Changing demographics – is it for real?

National and regional cancer registries are pivotal in providing an in-depth look at the epidemiological map of prostate cancer across Asia. The number of cases of prostate cancer reported in the listed Asian countries ranged from 24–558 during 1978–1982 to 146–1654 during 1993–1997. Age-standardised incidence rates per 100,000 man-years for prostate cancer from Asian countries over a 20-year period from 1978 to 1997 confirmed that the incidence of prostate cancer has risen 5–118% in most of

Conclusion

Prostate cancer incidence and mortality rates have shown a rising trend over the last two decades but still remain lower in Asia than in Western countries. The difference may be the result of genetic factors and certain protective lifestyle, dietary or environmental factors. However, with globalisation and gradual Westernisation, many Asian countries may be losing their protective cultural factors and acquiring high-risk ones. A better understanding of how these factors interact to cause

Conflict of interest statement

None declared.

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