Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Department of Population Science, American Cancer Society, Atlanta, GA, United States.
Environ Res. 2024 Oct 15;259:119560. doi: 10.1016/j.envres.2024.119560. Epub 2024 Jul 4.
Per- and polyfluoroalkyl substances (PFAS) are environmentally persistent, potentially carcinogenic chemicals. Previous studies investigating PFAS exposure and prostate cancer yielded mixed findings. We aimed to investigate associations between PFAS exposure and incident prostate cancer in a large cohort of U.S. men, overall and by selected demographic, lifestyle, and medical-related characteristics.
We conducted a case-cohort study among Cancer Prevention Study-II LifeLink Cohort participants who, at baseline (1998-2001), had serum specimens collected and no prior cancer diagnosis. The study included all men diagnosed with prostate cancer (n = 1610) during follow-up (baseline-June 30, 2015) and a random sub-cohort of 500 men. PFAS concentrations [perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorooctanoic acid (PFOA)] were measured in stored serum specimens. We used multivariable Cox proportional hazards models to estimate associations between PFAS concentrations and prostate cancer, overall and by selected characteristics (grade, stage, family history, age, education, smoking status, and alcohol consumption).
Prostate cancer hazards were slightly higher among men with concentrations in the highest (Q4) vs lowest quartile (Q1) for PFHxS [hazard ratio (HR) (95% CI): 1.18 (0.88-1.59)] and PFOS [HR (95% CI): 1.18 (0.89-1.58)], but not for PFNA or PFOA. However, we observed heterogeneous associations by age, family history of prostate cancer (PFHxS), alcohol consumption (PFHxS), and education (PFNA). For example, no meaningful associations were observed among men aged <70 years at serum collection, but among men aged ≥70 years, HRs (95% CIs) comparing Q4 to Q1 were PFHxS 1.54 (1.02-2.31) and PFOS 1.62 (1.08-2.44). No meaningful heterogeneity in associations were observed by tumor grade or stage.
Our findings do not clearly support an association between the PFAS considered and prostate cancer. However, positive associations observed in some subgroups, and consistently positive associations observed for PFHxS warrant further investigation.
全氟和多氟烷基物质（PFAS）是具有环境持久性、潜在致癌性的化学物质。先前研究 PFAS 暴露与前列腺癌的结果存在差异。我们旨在调查美国男性中 PFAS 暴露与前列腺癌发病的相关性，总体上以及按特定的人口统计学、生活方式和与医疗相关的特征进行调查。
我们在癌症预防研究-II 生命联系队列参与者中进行了病例-队列研究，这些参与者在基线（1998-2001 年）采集了血清样本，且此前未被诊断出患有癌症。该研究包括所有在随访期间（基线至 2015 年 6 月 30 日）被诊断为前列腺癌（n=1610）的男性和随机选择的 500 名男性。在储存的血清样本中测量了 PFAS 浓度[全氟己烷磺酸（PFHxS）、全氟辛烷磺酸（PFOS）、全氟壬酸（PFNA）和全氟辛酸（PFOA）]。我们使用多变量 Cox 比例风险模型来估计 PFAS 浓度与前列腺癌的相关性，总体上以及按选定特征（分级、分期、家族史、年龄、教育、吸烟状况和饮酒状况）进行估计。
PFHxS（危险比（HR）（95%可信区间）：1.18（0.88-1.59））和 PFOS（HR（95% CI）：1.18（0.89-1.58））浓度最高（Q4）与最低（Q1）四分位数的男性前列腺癌风险略高，但 PFNA 或 PFOA 则不然。然而，我们观察到 PFHxS 的年龄（PFHxS）、前列腺癌家族史（PFHxS）、饮酒（PFHxS）和教育（PFNA）等因素存在异质性关联。例如，在采集血清时年龄<70 岁的男性中未观察到有意义的关联，但在采集血清时年龄≥70 岁的男性中，Q4 与 Q1 相比的 HR（95% CI）分别为 PFHxS 1.54（1.02-2.31）和 PFOS 1.62（1.08-2.44）。肿瘤分级或分期未观察到有意义的关联异质性。
我们的研究结果并不明确支持所考虑的 PFAS 与前列腺癌之间的关联。然而，在一些亚组中观察到的阳性关联，以及对 PFHxS 的持续阳性关联值得进一步研究。
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