Background: The central role of prostate-specific antigen (PSA) testing in the diagnosis of prostate cancer leads to the possibility that observational studies that report associations between risk factors and prostate cancer could be affected by detection bias. This study aims to investigate whether reported risk factors for prostate cancer are associated with PSA testing in a large middle-aged population-based cohort in the UK.
Methods: The cross-sectional association between a wide range of sociodemographic, lifestyle, dietary and health characteristics with PSA testing was examined in 212,039 men aged 40 69 years in UK Biobank.
Results: A total of 62,022 (29%) men reported they had ever had a PSA test. A wide range of factors was associated with a higher likelihood of PSA testing including age, height, education level, family history of prostate cancer, black ethnic origin, not being in paid/self-employment, living with a wife or partner, having had a vasectomy, being diagnosed with cancer or hypertension and having a high dietary intake of cereal, cooked and salad/raw vegetables, fresh fruit and tea. Conversely, socioeconomic deprivation, Asian ethnic origin, current smoking, low alcohol intake, high body-mass index, high coffee consumption and being diagnosed with diabetes, heart disease or stroke were associated with a lower likelihood of PSA testing.
Conclusions: A variety of sociodemographic, lifestyle and health-related characteristics are associated with PSA testing, suggesting that observed associations of some of these traits with risk for prostate cancer in epidemiological studies may be, at least partially, due to detection bias.
Littlejohns TJ, Travis RC, Key TJ, Allen NE (2016) Lifestyle factors and prostate-specific antigen (PSA) testing in UK Biobank: Implications for epidemiological research, Cancer Epidemiology, Volume 45, December 2016, Pages 40-46, ISSN 1877-7821, https://doi.org/10.1016/j.canep.2016.09.010
Prostate Cancer Epidemiology Consortium: Risk factors for prostate cancer
Prostate cancer is the most common type of cancer in men in the United Kingdom, yet few risk factors have been identified for the disease, other than age, family history and ethnicity. Circulating concentration of insulin-like growth factor (IGF)-I appears to be the only established risk factor prostate cancer that is potentially modifiable. The risk of being diagnosed with prostate cancer has increased markedly in the past 25 years, largely due to the increased use of prostate specific antigen (PSA) test. However, many of the prostate cancers detected as a result of PSA-testing are early stage disease that will not progress to clinical disease. The growing proportion of early, localised disease and decreasing numbers of advanced cancers can lead to difficulty in the interpretation of results from epidemiological studies and may partly account for the limited understanding of prostate cancer aetiology. Circulating IGF-I concentrations are associated with diet and predict prostate cancer risk in prospective studies, but questions remain including their relation to the time course of the disease, tumour characteristics, mortality, and the relevance of other related biomarkers. Further evidence is needed on the role in prostate cancer development of other hormones and nutritional biomarkers, as well of other characteristics such as dietary, anthropometric and lifestyle factors. We therefore plan a programme of analyses on prostate cancer (total and clinically relevant advanced stage, high grade and fatal disease) in the UK Biobank cohort, which has uniquely detailed clinical and biological measures on anthropometric indices and other clinical characteristics and questionnaire information on growth, puberty, and sexual behaviour, for which there is a paucity of information from other prospective studies of prostate cancer. UK Biobank has also collected PSA-testing history, information which will be directly relevant to understanding the relationship of PSA-testing with the diagnosis of prostate cancer in the UK.
We propose a research programme on hormonal, anthropometric, dietary and lifestyle factors and prostate cancer risk; this will extend the work of an existing consortium co-ordinated in the Cancer Epidemiology Unit Oxford, the Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group. Initially we will describe the distributions of potential prostate cancer risk factors for men in UK Biobank (including personal characteristics, anthropometry, diet, alcohol intake, physical activity and history of use of the prostate-specific antigen (PSA) blood test). This will provide information that will help in the planning of further analyses of prostate cancer by users.
Thomas J. Littlejohns, Ruth C. Travis, Tim J. Key, Naomi E. Allen, Lifestyle factors and prostate-specific antigen (PSA) testing in UK Biobank: Implications for epidemiological research, Cancer Epidemiology, Volume 45, December 2016, Pages 40-46, ISSN 1877-7821, https://doi.org/10.1016/j.canep.2016.09.010. (http://www.sciencedirect.com/science/article/pii/S1877782116301746)
|Lead investigator:||Dr. Ruth Travis|
|Lead institution:||University of Oxford|