Abstract
Objectives: The purpose was to review the etiologic role and the possible biologic mechanisms for physical activity in the primary prevention of prostate cancer and to identify future research priorities.
Methods: We conducted literature searches and systematically reviewed all the epidemiologic studies of physical activity and prostate cancer and the literature on the underlying biologic mechanisms.
Results: Among 24 previously conducted studies, 14 studies suggested an inverse association of physical activity on prostate cancer; however, no overall association was found in six studies and an increased risk of prostate cancer was observed amongst the most physically active men in four other studies. The methodologic limitations in these studies include variations in detection of latent disease and possible outcome misclassification, crude assessments of physical activity, inadequate control for confounding, and incomplete examination of effect modification.
Conclusions: Physical activity may have an inverse association with prostate cancer risk; however, the epidemiologic evidence is currently inconsistent and the magnitude of the risk reduction observed is small. These inconsistent results could be attributable, in part, to methodologic limitations of previous studies. Hence, further investigation of the etiologic role of physical activity is needed before more definitive conclusions can be made. Specifically, research studies should be designed to measure all types and parameters of physical activity throughout lifetimes. Furthermore, a better understanding of the biologic mechanisms and etiologically relevant time periods in prostate carcinogenesis when physical activity may be operative is needed, so that these studies can be properly designed.
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References
National Cancer Institute of Canada (1999) Canadian Cancer Statistics 1999, Toronto, Canada: NCIC.
Krahn MD, Mahoney JE, Eckman MH, Trachtenberg J, Pauker SG, Detsky AS (1994) Screening for prostate cancer: a decision analytic view. JAMA 272: 773–780.
Godley PA (1999) Prostate cancer screening: promise and peril a review. Cancer Detect Prev 23: 316–324.
Calciano R, Chodak GW, Garnick MB, Kuban DH, Resnick MI (1995) The prostate cancer conundrum. Patient Care 29: 84–104.
Newman J (1996) Epidemiology, diagnosis and treatment of prostate cancer. Radiol Tech 68: 39–64.
Goldenberg SL, Ramsey EW, Jewett MAS (1998) Prostate cancer. 6. Surgical treatment of localized disease. Can Med Assoc J 159: 1265–1271.
Warde P, Catton C, Gospodarowicz MK (1998) Prostate cancer. 7. Radiation therapy for localized disease. Can Med Assoc J 159: 1381–1388.
Adolfsson J (1995) Radical prostatectomy, radiotherapy or deferred treatment of localized prostate cancer? Cancer Surv 23: 141–148.
Altwein J, Ekman P, Barry M, et al. (1997) How is quality of life in prostate cancer patients influenced by modern treatment? The Wallenberg Symposium. Urology 49: 66–76.
Herr HW (1997) Quality of life in prostate cancer patients. CA Cancer J Clin 47: 207–217.
Brawley OW, Knopf K, Thompson I (1998) The epidemiology of prostate cancer part II: the risk factors. Sem Urol Oncol 16: 193–201.
Pentyala SN, Lee J, Hsich K, Waltzer WC, et al. (2000) Prostate cancer: a comprehensive review. Med Oncol 17: 85–105.
Bosland MC (2000) The role of steroid hormones in prostate carcinogenesis. J Natl Cancer Inst Monogr 27: 39–66.
Yip I, Heber D, Aronson W (1999) Nutrition and prostate cancer. Urol Clin N Am 26: 403–411.
Gronberg H, Damber L, Damber JE (1996) Total food consumption and body mass index in relation to prostate cancer risk: a case-control study in Sweden with prospectively collected exposure data. J Urol 155: 969–974.
Giovannucci E, Rimm EB, Ascherio A, et al. (1999) Smoking and risk of total and fatal prostate cancer in United States health professionals. Cancer Epidemiol Biomarkers Prev 8: 277–282.
Dennis LK (2000) Meta-analyses for combining relative risks of alcohol consumption and prostate cancer. Prostate 42: 56–66.
Hayes RB, Pottern LM, Strickler H, et al. (2000) Sexual behaviour, STDs and risks for prostate cancer. Br J Cancer 82: 718–725.
Bernal-Delgado E, Latour-Perez J, Pradas-Arnal F, Gomez-Lopez LI (1998) The association between vasectomy and prostate cancer: a systematic review of the literature. Fertil Steril 70: 191–200.
Sharma-Wagner S, Chokkalingam AP, Malker HSR, Stone BJ, McLaughlin JK, Hsing AW (2000) Occupation and prostate cancer risk in Sweden. J Occup Environ Med 42: 517–525.
Kamat AM, Lamm DL (1999) Chemoprevention of urological cancer. J Urol 161: 1748–1760.
Christen WG, Gaziano JM, Hennekens CH for the Steering Committee of the Physicians' Health Study II (2000) Design of Physicians' Health Study II — A randomized trial of beta-carotene, vitamins E and C, and multivitamins, in prevention of cancer, cardiovascular disease, and eye disease, and review of results of completed trials. Ann Epidemiol 10: 125–134.
Giovannucci E (1999) Tomatoes, tomato-based products, lycopene, and cancer: review of the epidemiologic literature. J Natl Cancer Inst 91: 317–331.
Brawley OW, Parnes H (2000) Prostate cancer prevention trials in the USA. Eur J Cancer 36: 1312–1315.
Golditz GA, Cannuscio CC, Frazier AL (1997) Physical activity and reduced risk of colon cancer: implications for prevention. Cancer Causes Control 8: 649–667.
Friedenreich CM, Thune I, Brinton LA, Albanes D (1998) Epidemiologic issues related to the association between physical activity and breast cancer. Cancer 83: 600–610.
Polednak AP (1976) College athletics, body size, and cancer mortality. Cancer 38: 382–387.
Whittemore As, Paffenbarger RS, Anderson K, Lee JE (1985) Early precursors of site-specific cancers in college men and women. J Natl Cancer Inst 74: 43–51.
Paffenbarger RS, Hyde RT, Wing AL (1987) Physical activity and incidence of cancer in diverse populations: a preliminary report. Am J Clin Nutr 45: 312–317.
Vena JE, Graham S, Zielezny M, Brasure J, Swanson MK (1987) Occupational exercise and risk of cancer. Am J Clin Nutr 45: 318–327.
Severson RK, Nomura AMY, Grove JS, Stemmerman GN (1989) A prospective analysis of physical activity and cancer. Am J Epidemiol 130: 522–529.
Albanes D, Blair A, Taylor PR (1989) Physical activity and risk of cancer in the NHANES I population. Am J Public Health 79: 744–750.
Lee I-M, Paffenbarger RS, Hsieh C-C (1992) Physical activity and risk of prostatic cancer among college alumni. Am J Epidemiol 135: 169–179.
Paffenbarger RS Jr, Lee I-M, Wong AL (1992) The influence of physical activity on the incidence of site-specific cancers in college alumni. In: Jacobs MM, ed. Exercise, Fat, and Cancer. New York: Plenum Press, pp. 7–15.
Lee IM, Paffenbarger RS Jr (1994) Physical activity and its relation to cancer risk: a prospective study of college alumni. Med Sci Sports Exerc 26: 831–837.
Thune I, Lund E (1994) Physical activity and the risk of prostate and testicular cancer: a cohort study of 53,000 Norwegian men. Cancer Causes Control 5: 549–556.
Hsing AW, McLaughlin JK, Zheng W, Gao Y-T, Blot WJ (1994) Occupation, physical activity, and risk of prostate cancer in Shanghai, People's Republic of China. Cancer Causes Control 5: 136–140.
Steenland K, Nowlin S, Palu S (1995) Cancer incidence in the National Health and Nutrition Survey I follow-up data: diabetes, cholesterol, pulse and physical activity. Cancer Epidemiol Biomarker Prev 4: 807–811.
Ilié M, Vlajinac H, Marinković J (1996) Case-control study of risk factors for prostate cancer. Br J Cancer 74: 1682–1686.
Oliveria SA, Kohl HW, Trichopoulos D, Blair SN (1996) The association between cardiorespiratory fitness and prostate cancer. Med Sci Sports Exerc 28: 97–104.
Cerhan JR, Torner JC, Lynch CF, et al. (1997) Association of smoking, body mass, and physical activity with risk of prostate cancer in the Iowa 65+ Rural Health Study (United States). Cancer Causes Control 8: 229–238.
Hartman TJ, Albanes D, Tautalahti M, et al. (1998) Physical activity and prostate cancer in the Alpha-Tocopherol, Beta-Carotene (ATBC) Cancer Prevention Study (Finland). Cancer Causes Control 9: 11–18.
Giovannucci E, Leitzmann M, Spiegelman D, et al. (1998) A prospective study of physical activity and prostate cancer in male health professionals. Cancer Res 58: 5117–5122.
Liu S, Lee I-M, Linson P, Ajani U, Buring JE, Hennekens CH (2000) A prospective study of physical activity and risk of prostate cancer in US physicians. Int J Epidemiol 29: 29–35.
Lund Nilsen TI, Johnsen R, Vatten LJ (2000) Socio-economic and lifestyle factors associated with risk of prostate cancer. Br J Cancer 82: 1358–1363.
Yu H, Harris RE, Wynder EL (1988) Case-control study of prostate cancer and socioeconomic factors. Prostate 13: 317–325.
Brownson RC, Chang JC, Davis JR, Smith CA (1991) Physical activity on the job and cancer in Missouri. Am J Public Health 81: 639–642.
Le Marchand L, Kolonel LN, Yoshizawa CN (1991) Lifetime occupational physical activity and prostate cancer risk. Am J Epidemiol 133: 103–111.
West DW, Slattery ML, Robison LM, French TK, Mahoney AW (1991) Adult dietary intake and prostate cancer risk in Utah: a case-control study with special emphasis on aggressive tumors. Cancer Causes Control 2: 85–94.
Dosemeci M, Hayes RB, Vetter R, et al. (1993) Occupational physical activity, socioeconomic status, and risks of 15 cancer sites in Turkey. Cancer Causes Control 4: 313–321.
Andersson S-O, Baron J, Wolk A, Lindgren C, Bergström R, Adami H-O (1995) Early life risk factors for prostate cancer: a population-based case-control study in Sweden. Cancer Epidemiol Biomarkers Prev 4: 187–192.
Whittemore AS, Kolonel LN, Wu AH, et al. (1995) Prostate cancer in relation to diet, physical activity, and body size in blacks, whites, and Asians in the United States and Canada. J Natl Cancer Inst 87: 652–661.
Sung JFC, Lin RS, Pu Y-S, Chen Y-C, Chang HC, Lai M-K (1999) Risk factors for prostate carcinoma in Taiwan: a case-control study in a Chinese population. Cancer 86: 484–491.
Villeneuve PJ, Johnson KC, Kreiger N, Mao Y, and the Canadian Cancer Registries Epidemiology Research Group (1999) Risk factors for prostate cancer: results from the Canadian National Enhanced Cancer Surveillance System. Cancer Causes Control 10: 355–367.
Bairati I, Larouche R, Meyer F, Moore L, Fradet Y (2000) Lifetime occupational physical activity and incidental prostate cancer. Cancer Causes Control 11: 759–764.
World Health Organization (1998) Obesity. Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: World Health Organization.
Carroll KK (1998) Obesity as a risk factor for certain types of cancer. Lipids 33: 1055–1059.
Fox SB, Persad RA, Coleman N, Silcocks PB (1993) Natural history of prostate cancer. Lancet 341: 699.
Mandelson MT, Wagner EH, Thompson RS (1995) PSA screening: a public health dilemma. Annu Rev Public Health 16: 283–306.
Guileyardo JM, Johnson WD, Welsh RA, Akazaki K, Correa P (1980) Prevalence of latent prostate carcinoma in two U.S. populations. J Natl Cancer Inst 65: 311–316.
Wilding G (1995) Endocrine control of prostate cancer. Cancer Surv 23: 434–462.
Yatani R, Chigusa I, Akazaki K, Stemmermann GN, Walsh RA, Correa P (1982) Geographic pathology of latent prostatic carcinoma. Int J Cancer 29: 611–616.
Akazaki K, Stemmerman GN (1973) Comparative study of latent carcinoma of the prostate among Japanese in Japan and Hawaii. J Natl Cancer Inst 50: 1137–1144.
Breslow N, Chan CW, Dhom G, et al. (1977) Latent carcinoma of prostate at autopsy in seven areas. Int J Cancer 20: 680–688.
Wynder EL, Laakso K, Sotarauta M, Rose DP (1984) Metabolic epidemiology of prostatic cancer. Prostate 5: 47–53.
Huggins C, Hodges CV (1941) Studies on prostatic cancer: effect of castration, of estrogen, and of androgen injection on serum phosphases in metastatic carcinoma of the prostate. Cancer Res 1: 293–297.
Coffey DS (1979) Physiological control of prostatic growth. In: Prostate Cancer, an Overview. UICC Worshop on Prostatic Cancer. Technical Report Series, vol. 48. Geneva: International Union Against Cancer. pp. 4–23.
Noble RL (1977) The development of prostatic adenocarcinoma in Nb rats following prolonged sex hormone administration. Cancer Res 37: 1929–1933.
Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MJ (1996) Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 88: 1118–1126.
Ross R, Bernstein L, Judd H, Hanisch R, Pike M, Henderson B (1986) Serum testosterone levels in healthy young black and white men. J Natl Cancer Institute 76: 45–48.
Griffiths K, Eaton CL, Davies P (1989) Prostatic cancer: aetiology and endrocrinology. Horm Res 32(Suppl.): 38–43.
Ross RK, Henderson BE (1994) Do diet and androgens alter prostate cancer risk via a common etiologic pathway? J Natl Cancer Inst 86: 252–253.
Brawley OW, Ford LG, Thompson I, Perlman JA, Kramer BS (1994) 5-α-reductase inhibition and prostate cancer prevention. Cancer Epidemiol Biomarkers Prev 3: 177–182.
Aakvaag A, Sand T, Opstad PK, Fonnum F (1978) Hormonal changes in serum in young men during prolonged physical strain. Eur J Appl Physiol 39: 283–291.
Dessypris A, Kuoppasalmi K, Adlercreutz H (1976) Plasma cortisol, testosterone, androstenedione and luteinizing hormone (LH) in a non-competitive marathon run. J Steroid Biochem Mol Biol 7: 33–37.
Hackney AC, Sinning WE, Bruot BC (1988) Reproductive hormonal profiles of endurance-trained and untrained males. Med Sci Sports Exerc 20: 60–65.
Hackney C, Sinning WE, Bruot BC (1990) Hypothalamic-pituitary-testicular axis function in endurance-trained males. Int J Sports Med 11: 298–303.
Morville R, Pesquies PC, Guezennec CY, et al. (1979) Plasma variations in testicular and adrenal androgens during prolonged physical exercise in man. Ann Endocrinol (Paris) 40: 501–510.
Strauss RH, Lanese RR, Malarkey WB (1985) Weight loss in amateur wrestlers and its effect on serum testosterone levels. JAMA 254: 3337–3338.
Wheeler GD, Wall SR, Belcastro AN, et al. (1984) Reduced serum testosterone and prolactin levels in male distance runners. JAMA 254: 514–516.
Siiteri PK (1987) Adipose tissue as a source of hormones. Am J Clin Nutr 45: 277–282.
Mantzoros CS, Georgiadis EI (1995) Body mass and physical activity are important predictors of serum androgen concentrations in young healthy men. Epidemiology 6: 432–435.
Fishman J, Boyar RM, Hellman L (1975) Influence of body weight on estradiol metabolism in young women. J Clin Endocrinol 41: 989–991.
Forney JP, Milewich L, Chen GT, et al. (1981) Aromatization of androstenedione to estrone by human adiopose tissue in vitro. Correlation with adipose tissue mass, age and endometrial neoplasms. J Clin Endocrinol Metab 53: 192–199.
Bosland MC, Oakley-Girvan I, Whittemore AS (1999) Dietary fat, calories and prostate cancer risk. J Natl Cancer Inst 91: 489–491.
Kiningham RB (1998) Physical activity and the primary prevention of cancer. Oncology 25: 515–536.
Adlercreutz H (1990) Western diet and Western diseases: some hormonal and biochemical mechanisms and associations. Scand J Clin Lab Invest 50(Suppl.): 3–23.
Lee IM (1995) Exercise and physical health: cancer and immune function. Res Q Exerc Sport 66: 286–291.
Shephard RJ, Shek PN (1995) Heavy exercise, nutrition and immune function: is there a connection? Int J Sports Med 16: 491–497.
Hoffman-Goetz L (1998) Influence of physical activity and exercise on innate immunity. Nutr Rev 56: S126–130.
Nieman DC, Pedersen BK (1999) Exercise and immune function. Recent developments. Sports Med 27: 73–80.
Woods JA, Davis MJ, Smith JA, Nieman DC (1999) Exercise and cellular innate immune function. Med Sci Sports Exerc 31: 57–66.
Nieman DC (1997) Exercise immunology: practical applications. Int J Sports Med 18: 91–100.
Marnett LJ (1987) Peroxyl free radicals: potential mediators of tumor initiation and promotion. Carcinogenesis 9: 519–526.
Ji LL (1995) Exercise and oxidative stress: role of the cellular antioxidant systems. Exerc Sport Sci Rev 23: 135–166.
Clinton SK (1999) The dietary antioxidant network and prostate carcinoma. Cancer 86: 1629–1631.
Giuliani A, Cestaro B (1997) Exercise, free radical generation and vitamins. Eur J Cancer Prev 6: S55–S67.
Begg CB (1994) Methodological issues in studies of the treatment, diagnosis and etiology of prostate cancer. Sem Oncol 21: 569–579.
Kannel WB, Sorlie P (1979) Some benefits of physical activity: the Framingham Study. Arch Intern Med 139: 857–861.
Thune I, Njolstad I, Lochen ML, Forde OH (1998) Physical activity improves the metabolic risk profiles in men and women: the Tromso Study. Arch Intern Med 158: 1633–1640.
Chasan-Taber S, Rimm EB, Stampfer MJ, et al. (1996) Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology 7: 81–86.
Meikle AW, Smith JA Jr (1990) Epidemiology of prostate cancer. Urol Clin N Am 17: 709–718.
Kolonel LN (1996) Nutrition and prostate cancer. Cancer Causes Control 7: 83–94.
McTiernan A, Ulrich C, Slate S, Potter J (1998) Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control 9: 487–509.
Hebert PR, Ajani U, Cook NR, Lee I-M, Chan KS, Hennekens CH (1997) Adult height and incidence of cancer in male physicians (United States). Cancer Causes Control 8: 591–597.
Lund Nilsen TI, Vatten LJ (1999) Anthropometry and prostate cancer risk: a prospective study of 22,248 Norwegian men. Cancer Causes Control 10: 269–275.
Schuurman AG, Goldbohm RA, Dorant E, van den Brandt PA (2000). Anthropometry in relation to prostate cancer risk in the Netherlands Cohort Study. Am J Epidemiol 151: 541–549.
Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Willett WC (1997) Height, body weight, and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 6: 557–563.
Andersson SO, Wölk A, Bergström R, et al. (1997) Body size and prostate cancer: a 20-year follow-up study among 135006 Swedish construction workers. J Natl Cancer Inst 89: 385–389.
Hamalainen EK, Adlercreutz H, Puska P, Pietinen P (1983) Decrease of serum total and free testosterone during a low-fat high-fibre diet. J Steroid Biochem 18: 369–370.
Hamalainen E, Adlercreutz H, Puska P, Pietinen P (1984) Diet and serum hormones in healthy men. J Steroid Biochem 20: 459–464.
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Friedenreich, C.M., Thune, I. A review of physical activity and prostate cancer risk. Cancer Causes Control 12, 461–475 (2001). https://doi.org/10.1023/A:1011210121901
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DOI: https://doi.org/10.1023/A:1011210121901