[Epidemiology of prostate cancer]

Since a number of years, prostate cancer has been the most frequent cancer site among men in Germany and has replaced lung cancer as the leading position. Among the most frequent cancer sites, it is the one with the lowest available knowledge about etiology. Smoking and alcohol apparently do not play a role. Regarding food intake, indications exist for a protective association to tomatoes or lycopene consumption and a protective association was also seen with high physical activity, while risk seems to be elevated in obese men. Associations to hormonal factors have been observed and are under consideration. Trials with potential chemopreventive agents have been unsuccessful so far. For early detection, digital rectal examination has been part of the German statutory early detection program" from the very beginning in 1971 and the test for prostate specific antigen (PSA) is being used in the framework of the so-called individual health services, both without scientific evidence of effectiveness. The available data show that the progression of prostate cancer to the leading male cancer site was chiefly driven by the unstructured introduction of the PSA test as a screening tool. Cynically addressed, the figures indicate that the most efficient known preventive intervention was not to attend screening. This delicate situation should, however, not discourage from further examinations of prostate cancer screening. Recent results including the European randomized prostate cancer screening study (ERSPC) indicated that intelligently structured screening, possibly even using the PSA test, might be effective. Before routine application the novel approaches also have to be scrutinized in a research setting.