East meets West: ethnic differences in prostate cancer epidemiology between East Asians and Caucasians

Abstract

Prostate cancer is the most prevalent cancer in males in Western countries. The reported incidence in Asia is much lower than that in African Americans and European Caucasians. Although the lack of systematic prostate cancer screening system in Asian countries explains part of the difference, this alone cannot fully explain the lower incidence in Asian immigrants in the United States and west-European countries compared to the black and non-Hispanic white in those countries, nor the somewhat better prognosis in Asian immigrants with prostate cancer in the United States. Soy food consumption, more popular in Asian populations, is associated with a 25% to 30% reduced risk of prostate cancer. Prostate-specific antigen(PSA) is the only established and routinely implemented clinical biomarker for prostate cancer detection and disease status. Other biomarkers, such as urinary prostate cancer antigen 3 RNA, may increase accuracy of prostate cancer screening compared to PSA alone. Several susceptible loci have been identified in genetic linkage analyses in populations of countries in the West, and approximately 30 genetic polymorphisms have been reported to modestly increase the prostate cancer risk in genome-wide association studies. Most of the identified polymorphisms are reproducible regardless of ethnicity. Somatic mutations in the genomes of prostate tumors have been repeatedly reported to include deletion and gain of the 8p and 8q chromosomal regions, respectively; epigenetic gene silencing of glutathione S-transferase Pi(GSTP1); as well as mutations in androgen receptor gene. However, the molecular mechanisms underlying carcinogenesis, aggressiveness, and prognosis of prostate cancer remain largely unknown. Gene-gene and/or gene-environment interactions still need to be learned. In this review, the differences in PSA screening practice, reported incidence and prognosis of prostate cancer, and genetic factors between the populations in East and West factors are discussed.

Figure 1.. Age-standardized incidence and mortality of prostate cancer in selected countries.

Data were obtained from GLOBOCAN 2008 [http://globocan.iarc.fr/]. Incidence and mortality in all ages (0 to 75 years) were standardized using the world standard population.

Figure 2.. Age-standardized incidence and mortality of prostate cancer and PSA screening rates in Asians in the United States.

Incidence and mortality in the US population (non-Hispanic whites and Asian Americans) standardized by using the 2000 US Standard Population and 95% confidence interval were obtained from Miller et al. based on Surveillance, Epidemiology, and End Results data from 1998–2002. The PSA screening rates in men aged 50 years and older who had heard of and underwent the PSA test was obtained from California Health Interview Survey of 2003.