Dr. Mohamad Nizam Bin SubahirMD (USU), M.Comm.Med(Epid & Stat)(UKM)

INTRODUCTIONProstate Cancer Distribution

Worldwide prostate cancer incidence is 25.3 per 100,000 populations (Nelen V. 2007).

In Malaysia, Incidence rate was 10.3 per 100,000 population (NCR 2003).

Expected to increase in the future with an increasing ageing population.

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INTRODUCTIONEtiology: remain poorly understood but

many evidence correlate the incidence of prostate cancer with multiple factors such as genetic, occupation, diet, hormonal disturbances, sexual activity and sexual transmitted disease (O’Reilly 1999)

Justification: This study is important because this is the first time for this kind of study done in Malaysia to recognize the risk factors for prostate cancer.

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Frame Work of Study

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Study ObjectiveGeneral Objective

To determine the relationship between risk factors and prostate cancer patients who came for treatment at Universiti Kebangsaan Malaysia Medical Centre (UKMMC).

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METHODOLOGY

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Consent Form

ControlCase

Histopatologically confirmed diagnose primer prostate

cancer

Qualified

Questionnaire

Screening based on IPSS (Int. Prostate Symptom Score)

Normal PSA (0-4ng/ml)

Questionnaire

Has symptom

Not Qualified

Qualified

No symptom

Results

Statistic test

Not Normal PSA (>4ng/ml)

Already undergone biopsy and proven not has malignancy cell

Statistical AnalysisStatistical significance was considered if p<

0.05. The relation between risk factors and

prostate cancer was examined using software of McNemar Calculator to calculate the (ORM).

For conditional logistic regression using the software SPSS version 12.0 to calculate the adjusted odds ratio.

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RESULTS & DISCUSSIONEthnic Distribution

50%46.40%

3.60%

ChineseMalayIndian

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0

10

2030

4050

60

Frequancy

Age Class

Age Class Distribution

50-59

60-69

70-79

≥80

The ethnic group and age distribution among patient in this study group is almost similar to that of the second report of National Cancer Registry (NCR 2003).

When men become older, prostate is the most pathologically transform organ (Groven & Martin 2002)

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McNemar Odds Ratio (ORM)

Table 1 till 5 will illustrates the McNemar Odds Ratio (ORM) and related 95% CI for prostate cancer with sociodemographic, lifestyle, diet, medical problem and occupational exposure with different frequency.

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In term of sociodemographic (education, income & married), no significant risk were found with prostate cancer.

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Table 2: McNemar analysis for significant lifestyle factor

Variable Cases Control ORM P value

(+) (-) (95% CI)

Freq. Sexual Intercourse

Low (+) High (-)

36 4119 16

0.46(0.25-0.82)

0.007*

Exercise Not Frequent (+) Frequent (-)

76 22 9 5

0.41(0.67-0.93)

0.03*

Daily Works Activity

Sedentary (+) Strenuous (-)

21 4424 23

0.55(0.32-0.92)

0.02*

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* significant at p< 0.05

Table 3: McNemar analysis for significant medical factor

Variable Cases Control ORM P value

(+) (-) (95% CI)

Family Ca Yes (+) No (-)

4 207 81

2.87 (1.62-7.99)

0.02*

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* significant at p< 0.05

Table 4: McNemar analysis for significant occupational factor

Variable Cases Control ORM P value

(+) (-) (95% CI)

Pesticide Yes (+)No (-)

9 2410 69

2.40 1.11-5.62

0.03*

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* significant at p< 0.05

Table 5: McNemar analysis for study variable of diet

Variable Cases Control ORM P value

(+) (-) (95% CI)

Vegetables Frequent (+) Not Frequent (-)

89 419 0

0.21 (0.05-0.63)

0.004*

Fruits Frequent (+) Not Frequent (-)

80 822 2

0.36 (0.14-0.85)

0.018*

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Tomatoes Frequent (+) Not Frequent (-)

4 1332 63

0.41 (0.20-0.80)

0.007*

Meat Frequent (+) Not Frequent (-)

6 468 52

5.75 (2.69-14.11)

0.001*

Fish Frequent (+) Not Frequent (-)

9 512 0

0.42 (0.12-1.27)

0.15

* significant at p< 0.05

Multivariate Analysis

Table 6, 7 & 8 will shows the adjusted odds ratio from conditional logistic regression model for prostate cancer.

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Table 6: Conditional Logistic Regression model for prostate cancer

Risk Factors

ß Wald P

Pesticide No Yes 1.718 8.419 0.004*

Family History Ca

No Yes 1.327 5.154 0.023*

Meat Not FrequentFrequent 2.511 18.242 0.001*

OR(95% CI)

1.05.572

(1.746-17.780)

1.0 3.768

(1.199-11.846)

1.012.232

(3.892-39.013)

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* significant at p< 0.05

Histories of exposed to pesticide with prostate cancer consistent with other studies (Meyer et al. (2006) and Alavanja et al. (2003)

Pesticide content such as glyphosate isopropylamine and paraquat are not yet proven as carcinogens but have potential.

Family history of other cancer was found increase risk for prostate cancer also consistent with other studies (Villeneuve et al. 1999; Freindenreich et al. 2004)

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Table 7: Conditional Logistic Regression model for prostate cancer

Vegetables Not FrequentFrequent -2.120 4.560 0.033*

Tomatoes Not FrequentFrequent -1.039 4.470 0.035*

Sexual Int. Frequency

Low High -0.832 4.217 0.040*

1.00.120

(0.017-0.840) 1.0

0.354 (0.135-0.927)

1.00.435

(0.197-0.963)

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* significant at p< 0.05

Frequent intake of vegetables & tomatoes reduced risk consistent with other studies.

Frequent SI was found to be associated with prostate cancer gave protective effect till 57%.

Leitzman et al.(2004) found that frequent ejaculation equal or more 21 times per month compared to those who had only 4-7 times will significantly reduced risk for prostate cancer with MRR 0.67 (95%CI: 0.51-0.89).

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Table 8: Conditional Logistic Regression model for prostate cancer

Fruits Not FrequentFrequent 0.108 0.024 0.876

Exercise Not FrequentFrequent -0.205 0.106 0.745

Daily Works Activity

Sedentary Strenuous -0.440 1.546 0.214

1.01.114

(0.286-4.337) 1.0

0.815(0.238-2.789

1.00.644

(0.322-1.289)

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RecommendationsScreening with PSA before age 50 & repeat if

necessary.Encourage public since school age to frequent

intake of vegetables, fruits and tomatoes and limit intake of meat.

Encourage public do more exercise.Population-based matched case control study.Cross-sectional study (eg; M’sian diet habit)KAP study to worker (eg; use of PPE).

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CONCLUSIONThe present study suggests that some life

style and occupation factors are strong predictors of the occurrence of prostate cancer.

More importantly, with the identification of the potentially modifiable risk factors, proper public health intervention can be improved.

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REFERENCES Alavanja, M.C.R., Samanic, C., Dosemeci, M., Lubin, J., Tarone, R., Lynch, C.F.,Knott, C., Thomas, K.,

Hoppin, J.A., Barker, J., Coble, J., Sandler, D.P. and Blair, A. 2003. Use of Agriculture Pesticide and Prostate Cancer Risk in the Agrictultural Health study Cohort. American Journal of Epedemiology. Vol.157. No.9: 800-814.

Augustsson, K.M., Michaud, D.S., Rimm, E.B., Stampfer, M.J., Willet, W.C. and Giovannucci, E. 2003. A prospective study of intake of fish and marine fatty acids and prostate cancer. Cancer Epidemiology, Biomarkers & Prevention. Vol 12, 64-67.

Bravi, F., Scotti,L.,Bosetti,C., Talamani,R.,Negri,E., Montella,M.,Franceschi,S.& La Veechia,C. 2006. Sel- reported history of hypercolesterolemia and

gallstone and the risk of prostate cancer. Annals of Oncology. CDC.2008. http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html [14 Jun 2008]. Chan, J.M. and Gionannuci, E.L. 2001. Vegetables, Fruits, Associated Micronutrients and Risk of

Prostate Cancer. Epidemiologic Reviews. John Hopkins University Bloomberg School of Public Health Cohen, J., Kristal, A. And Stanford, J. (2000). Fruits and vegetables intakes and Prstate Cancer Risk. J

Natl Cancer Inst 92: 61-68 Dennis, L.K and Hayes, R.B. 2001. Alcohol and Prostate Cancer. Epidemiologic review by the Johns

Hopkins University Bloomberg School of Public Health. Vol. 23, No. 1. De Roos, A.J., 2008. Research on Long Term Health Effect of Pesticide. Fred Hutchinson Cancer

Centre. Freindenreich,C.M., McGregor,S.E., Courneya, K.S., Angyalfi, S.E & Elliot, F.G. 2004. Case-control

study of Lifetime Total Physical Activity & Prostate Cancer Risk. American Journal of Epidemiology. Vol 159. No.8

Giovannuci, E., Ascherio, A., Rimm, E. and Wigo, P.A. 1995. Intakes of Carotenoids and retinol in relation to risk of Prostate Cancer. J Natl Cancer Inst 87: 1767-1776

Grover, L.P. and Martin, F.L. (2002). The initiation of breast and prostate cancer. Carcinogenesis. vol.23.no.7. pp. 1095-1102.

Haas, G.P. and Sakr, W.A. 1997. Epidemiology of Prostate Cancer. CA Cancer J. Clin : 47: 273-287

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THANK YOU…

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