Should Military Veterans Be Classified as High Risk for Prostate Cancer Screening? A Systematic Review and Meta-analysis.

OBJECTIVE

To assess the unique risks of prostate cancer among U.S. veterans, and to advocate for improved care by raising awareness of the gaps in current AUA guidelines that do not address the specific needs of military personnel and veterans.

METHODS

Ovid interface, Google Scholar, PubMed, and Medline were searched for studies investigating prostate cancer in veterans published between 1975 and 2023. Search terms: "veteran", "military", "molecular markers", "prostate cancer", "prostate cancer risk", and "military exposure" were used. Articles meeting inclusion criteria underwent analysis, data synthesis, and meta-analysis where applicable.

RESULTS

Results from 45 articles indicate a significant increase in prostate cancer risk associated with exposure to Agent Orange (OR 1.97 [95% CI: 1.64-2.37], P <.00001), aromatic hydrocarbons (OR 1.14 [95% CI: 1.01-1.28], P = .03), and a slight increase with cadmium exposure (OR 1.03 [95% CI: 0.96-1.09], P = .42). While some evidence suggests an association between Camp Lejeune and prostate cancer risk in retrospective cohort studies, logistical regression analysis study did not entirely substantiate this relationship.

CONCLUSION

This review identifies several exposures that elevate prostate cancer risk. Military veterans should be further questioned about their exposures and potentially treated as a high-risk screening group. Further research is warranted to strengthen these associations, as the current evidence remains limited.