Meikle A W, Smith J A
Department of Medicine, University of Utah Center for the Health Sciences, Salt Lake City.
Urol Clin North Am. 1990 Nov;17(4):709-18.
Available epidemiologic data do not allow targeting of specific populations for prostate cancer screening or early detection programs. Although certain strong factors have been identified (age, race, location), none sufficiently defines high-risk groups in whom recommendations should differ from those of other age-matched patients. Certainly, a strong familial tendency has been identified, but the relative contribution of genetic and environmental factors in these patients remains unclear. Some hypotheses on the pathogenesis of prostate cancer are possible based on the available data. Genetic factors appear to be permissive, as are hormonal influences, which are partially regulated by genetics. Environmental factors appear to be promotional in genetically susceptible men. Dietary fat may also be an important promotional factor in genetically susceptible men. Dietary factors appear to exert some influence by modulating sex hormone concentration. Several factors demand more investigation and understanding of the epidemiology of prostate cancer. The relative frequency of the disease and the increasing death rate from prostate cancer are of concern. The similarities in the incidence of latent prostate cancer among various groups with strong differences in the rate of clinically apparent disease raise significant issues regarding potential lifestyle or environmental promotional factors. Further understanding of the pathogenesis of prostate cancer may allow a refinement and definition of programs for prevention and early detection of the disease.
现有的流行病学数据无法针对特定人群开展前列腺癌筛查或早期检测项目。尽管已确定了某些显著因素（年龄、种族、地理位置），但这些因素均不足以明确高危人群，而针对高危人群的建议应与其他年龄匹配患者的建议有所不同。诚然，已确定存在强烈的家族倾向，但这些患者中遗传因素和环境因素的相对作用仍不明确。基于现有数据，关于前列腺癌发病机制的一些假说具有可能性。遗传因素似乎具有容许性，激素影响同样如此，而激素影响部分受遗传调控。环境因素似乎在基因易感性男性中具有促进作用。膳食脂肪在基因易感性男性中也可能是一个重要的促进因素。膳食因素似乎通过调节性激素浓度发挥一定影响。有几个因素需要对前列腺癌流行病学进行更多的研究和了解。该疾病的相对发病率以及前列腺癌死亡率的上升令人担忧。在临床显性疾病发生率存在显著差异的不同群体中，潜伏性前列腺癌发病率的相似性引发了关于潜在生活方式或环境促进因素的重大问题。对前列腺癌发病机制的进一步了解可能有助于完善和界定该疾病的预防及早期检测项目。
