Epidemiology, Risk Factors, and Prevention of Prostate Cancer.

CONTEXT: There are substantial regional differences in prostate cancer (PCa) epidemiology reflecting differences in risk factors, screening, management, and access to care.

OBJECTIVE

To assess geographical differences and temporal trends in PCa incidence and mortality and PCa risk factors.

EVIDENCE ACQUISITION: Estimated incidence and mortality data for the year 2024 and projections to 2050 based on the assumption that 2024 age-specific incidence and mortality rates remain unchanged (not accounting for changes in risk factors and/or treatments) in 185 countries were derived from the International Agency for Research on Cancer's GLOBOCAN 2024 database. A narrative review of the literature summarized risk factors and preventive measures.

EVIDENCE SYNTHESIS: Worldwide, 1.55 million new PCa cases were estimated in 2024, with an age-standardized rate (ASR) for incidence of 29 per 100 000. Northern America had the highest all-age incidence ASR (81), and South-Central Asia the lowest (7.2). PCa caused an estimated 420 000 deaths (7.5 per 100 000), with the highest mortality ASRs in the Caribbean (29) and the lowest in South-Central Asia (3.4). By 2050, new cases are projected to be 2.88 million (+86%) and deaths 924 000 (+120%), with the largest relative increases in Africa (+156%). Prostate-specific antigen-based screening influences both incidence and geographic variation. Family history, germ line pathogenic variants, polygenic risk scores, and ancestry are risk factors. Disparities in men of African versus European ancestry reflect both tumor biology and unequal access to care, with mortality gaps narrowing in equal-access health systems. No single nutrient or supplement has been shown to reduce PCa incidence. Cigarette smoking and obesity are associated with PCa-specific mortality, whereas physical activity and plant-based or Mediterranean dietary patterns are associated with a lower risk of disease progression.

CONCLUSIONS

The global burden of PCa because of population increase and aging is projected to rise substantially by 2050, particularly in low- and middle-income regions. Family history, germ line pathogenic variants, and ancestry are risk factors for PCa. Evidence remains insufficient to support any specific preventive intervention, although smoking, diet, and physical activity may modify risk of progression or mortality.