Donn A S, Muir C S
Bull Cancer. 1985;72(5):381-90.
Prostatic cancer is a frequent tumour in old men. The disease is very common in North America, particularly among Blacks, and in Scandinavia, while it is currently rare in Asian countries. Both morbidity and mortality rates have increased in most areas in recent years, the rate of increase being greatest in populations where the risk has hitherto been low. "Latent" (microscopic) prostatic cancer is much commoner than overt clinical prostatic cancer and, in contrast to the latter, the prevalence is similar in a wide spectrum of countries and ethnic groups. Detection of these latent tumours is dependent on medical care variables. The relationships between tumor development, latency and progression are not understood. It may be useful to consider "latent" prostatic cancer as a separate entity in future classifications and epidemiological research. Hormonal, sexual, dietary, chemical and genetic factors have been implicated in the aetiology although the mechanisms by which they act and the relationships between these factors are not known. As a high fat diet has been found to increase risk in case-control studies, a plausible sequence of events would be a fat-induced change of hormone profile with increased uptake by the prostate of male sex hormones leading to carcinoma--as in the rat. The evidence is however by no means entirely consistent and should be explored further in studies of the US Black and White populations, populations with age-standardized incidence rates in the order of 100 and 50 per 100,000 per annum respectively. If it be accepted that the factors leading to latent carcinoma of prostate are evenly distributed throughout the world, then studies directed at uncovering the agents responsible for progression from latent to clinically invasive state could be rewarding. Such studies would need to be large, prospective in nature and would require a high frequency of autopsy of cohort members to ascertain whether the prostate was cancer free or not. Prevention is not feasible on the basis of current knowledge and further inquiry regarding the aetiopathogenesis of prostatic cancer is needed before preventive approaches can be envisaged.
前列腺癌是老年男性常见的肿瘤。该病在北美非常普遍，尤其是在黑人中，在斯堪的纳维亚半岛也很常见，而目前在亚洲国家较为罕见。近年来，大多数地区的发病率和死亡率都有所上升，在那些此前风险较低的人群中上升幅度最大。“潜伏性”（微观）前列腺癌比显性临床前列腺癌更为常见，与后者不同的是，其患病率在广泛的国家和种族群体中相似。这些潜伏性肿瘤的检测取决于医疗保健变量。肿瘤发生、潜伏和进展之间的关系尚不清楚。在未来的分类和流行病学研究中，将“潜伏性”前列腺癌视为一个单独的实体可能会有所帮助。激素、性、饮食、化学和遗传因素都与病因有关，尽管它们的作用机制以及这些因素之间的关系尚不清楚。在病例对照研究中发现高脂肪饮食会增加患病风险，一个合理的事件序列可能是脂肪引起激素谱变化，前列腺对雄性激素的摄取增加，从而导致癌症——就像在大鼠身上那样。然而，证据并不完全一致，应该在美国黑人和白人人群的研究中进一步探索，这些人群的年龄标准化发病率分别约为每年每10万人100例和50例。如果认为导致前列腺潜伏癌的因素在全世界分布均匀，那么旨在揭示从潜伏状态发展到临床侵袭状态的致病因素的研究可能会有收获。此类研究需要大规模、前瞻性进行，并且需要对队列成员进行高频率尸检，以确定前列腺是否无癌。基于目前的知识，预防是不可行的，在设想预防方法之前，需要对前列腺癌的病因发病机制进行进一步研究。
