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Epidemiology and genomics of prostate cancer in Asian men

Nature Reviews Urology volume 18, pages 282–301 (2021)Cite this article

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Abstract

Prostate cancer is a global health problem, but incidence varies considerably across different continents. Asia is traditionally considered a low-incidence area, but the incidence and mortality of prostate cancer have rapidly increased across the continent. Substantial differences in epidemiological features have been observed among different Asian regions, and incidence, as well as mortality-to-incidence ratio, is associated with the human development index. Prostate cancer mortality decreased in Japan and Israel from 2007 to 2016, but mortality has increased in Thailand, Kyrgyzstan and Uzbekistan over the same period. Genomic analyses have shown a low prevalence of ERG oncoprotein in the East Asian population, alongside a low rate of PTEN loss, high CHD1 enrichments and high FOXA1 alterations. Contributions from single-nucleotide polymorphisms to prostate cancer risk vary with ethnicity, but germline mutation rates of DNA damage repair genes in metastatic prostate cancer are comparable in Chinese and white patients from the USA and UK. Pharmacogenomic features of testosterone metabolism might contribute to disparities seen in the response to androgen deprivation between East Asian men and white American and European men. Overall, considerable diversity in epidemiology and genomics of prostate cancer across Asia defines disease characteristics in these populations, but studies in this area are under-represented in the literature. Taking into account this intracontinental and intercontinental heterogeneity, translational studies are required in order to develop ethnicity-specific treatment strategies.

Key points

  • The epidemiology and genomic features of prostate cancer vary considerably between Asian regions and countries and genomic data are scarce.

  • Prostate cancer incidence is still increasing in Asia; however, from 2007 to 2016, mortality has decreased in highly developed countries such as Japan and Israel but increased in developing countries such as Thailand, Kyrgyzstan and Uzbekistan.

  • PSA screening is not common in Asian countries, but evidence from Japan, where a screening programme has been recommended by the Japanese Urological Association since 2008, showed that screening decreased the incidence of metastatic disease from 21.3% in 2000 to 11.6% in 2014 and is associated with improved survival.

  • Rates of ERG oncoprotein-positive prostate cancer are low (13–22%) in East Asian men, whereas FOXA1 is more frequently (41%) mutated in Chinese men with localized prostate cancer than in white patients.

  • Genetic studies have revealed remarkably different gene polymorphisms in men with prostate cancer of East Asian and European descent, whereas the rate of germline mutations in DNA damage repair genes was comparable (12%) in these populations.

  • Pharmacogenomic studies of testosterone metabolism-related genes have revealed an inherent difference in testosterone metabolism between East Asian men and white populations from the USA and Europe, providing a potential explanation for differences observed in the efficacy of androgen deprivation therapy.

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Fig. 1: Age-standardized incidence and mortality rates of prostate cancer in Asian countries in 2020.
Fig. 2: Average annual percentage changes in prostate cancer incidence and mortality in Asian countries, England and the USA.
Fig. 3: Average annual percentage changes in age-specific prostate cancer mortality in selected Asian countries, England and the USA.
Fig. 4: The prevalence of metastatic prostate cancer in selected Asian countries, England and the USA.
Fig. 5: The androgen metabolism network and key regulator genes.

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  1. Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China

    Yao Zhu, Yu Wei, Junlong Wu, Jian Pan & Dingwei Ye

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Yao Zhu, Miao Mo, Yu Wei, Junlong Wu, Jian Pan, Ying Zheng & Dingwei Ye

  3. Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China

    Miao Mo & Ying Zheng

  4. Department of Surgery, Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Stephen J. Freedland

  5. Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, NC, USA

    Stephen J. Freedland

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Zhu, Y., Mo, M., Wei, Y. et al. Epidemiology and genomics of prostate cancer in Asian men. Nat Rev Urol 18, 282–301 (2021). https://doi.org/10.1038/s41585-021-00442-8

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