Prostate

# Prostate Cancer: The Age-Related Malignancy

## Introduction: The Most Common Male Cancer
Prostate cancer affects 1 in 8 men, with incidence rising sharply after age 65. This androgen-driven malignancy exhibits extreme biological heterogeneity, ranging from indolent lesions requiring no treatment to lethal variants. The introduction of PSA screening caused stage migration, with 90% of contemporary cases diagnosed at localized stages. Active surveillance now constitutes appropriate management for 60% of low-risk cases.

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## Causes and Risk Factors: Hormones and Heredity

### Established Risks
- **Age**: 60% of cases occur after 65
- **Ethnicity**: African ancestry confers 2× higher risk
- **Family History**: 1 first-degree relative doubles risk

### Emerging Risks
- **Inflammation**: Prostatitis history
- **STIs**: Trichomonas vaginalis association
- **Obesity**: Increases risk of aggressive variants

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## Prevention Strategies: Precision Screening

### Controversies in Screening
- **PSA Limitations**: Leads to overdiagnosis of indolent cancers
- **New Biomarkers**:
  - PHI (Prostate Health Index)
  - 4Kscore
  - PCA3 urine test

### Risk-Adapted Approaches
| Risk Group | Screening Strategy |
|------------|-------------------|
| General Population | Shared decision-making at 55 |
| High Risk (African ancestry/family history) | Begin at 45 |
| BRCA2 Carriers | Start at 40 with MRI fusion biopsy |

### Preventive Interventions
- 5α-reductase inhibitors for high-risk men
- Lycopene-rich diets (tomato products)
- Vigorous exercise (3+ hours/week)