Lifestyle Risk Prediction Model for Prostate Cancer in a Korean Population

  • Kim, Sung Han (Center for Prostate Cancer, National Cancer Center) ;
  • Kim, Sohee (Biometrics Branch, Research Institute, National Cancer Center) ;
  • Joung, Jae Young (Center for Prostate Cancer, National Cancer Center) ;
  • Kwon, Whi-An (Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine) ;
  • Seo, Ho Kyung (Center for Prostate Cancer, National Cancer Center) ;
  • Chung, Jinsoo (Center for Prostate Cancer, National Cancer Center) ;
  • Nam, Byung-Ho (Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center) ;
  • Lee, Kang Hyun (Center for Prostate Cancer, National Cancer Center)
  • Received : 2017.10.13
  • Accepted : 2017.12.19
  • Published : 2018.10.15


Purpose The use of prostate-specific antigen as a biomarker for prostate cancer (PC) has been controversial and is, therefore, not used by many countries in their national health screening programs. The biological characteristics of PC in East Asians including Koreans and Japanese are different from those in the Western populations. Potential lifestyle risk factors for PC were evaluated with the aim of developing a risk prediction model. Materials and Methods A total of 1,179,172 Korean men who were cancer free from 1996 to 1997, had taken a physical examination, and completed a lifestyle questionnaire, were enrolled in our study to predict their risk for PC for the next eight years, using the Cox proportional hazards model. The model's performance was evaluated using the C-statistic and Hosmer-Lemeshow type chi-square statistics. Results The risk prediction model studied age, height, body mass index, glucose levels, family history of cancer, the frequency of meat consumption, alcohol consumption, smoking status, and physical activity, which were all significant risk factors in a univariate analysis. The model performed very well (C statistic, 0.887; 95% confidence interval, 0.879 to 0.895) and estimated an elevated PC risk in patients who did not consume alcohol or smoke, compared to heavy alcohol consumers (hazard ratio [HR], 0.78) and current smokers (HR, 0.73) (p < 0.001). Conclusion This model can be used for identifying Korean and other East Asian men who are at a high risk for developing PC, as well as for cancer screening and developing preventive health strategies.


Supported by : National Cancer Center


  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87-108.
  2. Park SK, Sakoda LC, Kang D, Chokkalingam AP, Lee E, Shin HR, et al. Rising prostate cancer rates in South Korea. Prostate. 2006;66:1285-91.
  3. Huncharek M, Haddock KS, Reid R, Kupelnick B. Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies. Am J Public Health. 2010;100:693-701.
  4. Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2006;98:529-34.
  5. Jeong IG, Dajani D, Verghese M, Hwang J, Cho YM, Hong JH, et al. Differences in the aggressiveness of prostate cancer among Korean, Caucasian, and African American men: a retrospective cohort study of radical prostatectomy. Urol Oncol. 2016;34:3.e9-14.
  6. Andriole GL, Crawford ED, Grubb RL 3rd, Buys SS, Chia D, Church TR, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104:125-32.
  7. Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350:2239-46.
  8. Roobol MJ, Steyerberg EW, Kranse R, Wolters T, van den Bergh RC, Bangma CH, et al. A risk-based strategy improves prostate-specific antigen-driven detection of prostate cancer. Eur Urol. 2010;57:79-85.
  9. Park S, Nam BH, Yang HR, Lee JA, Lim H, Han JT, et al. Individualized risk prediction model for lung cancer in Korean men. PLoS One. 2013;8:e54823.
  10. Shin A, Joo J, Yang HR, Bak J, Park Y, Kim J, et al. Risk prediction model for colorectal cancer: National Health Insurance Corporation study, Korea. PLoS One. 2014;9:e88079.
  11. Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247:2543-6.
  12. D'Agostino RB, Nam BH. Evaluation of the performance of survival analysis models: discrimination and calibration measures. Handb Stat. 2003;23:1-25.
  13. D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P; CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286:180-7.
  14. Schroder F, Kattan MW. The comparability of models for predicting the risk of a positive prostate biopsy with prostate-specific antigen alone: a systematic review. Eur Urol. 2008;54:274-90.
  15. Shariat SF, Karakiewicz PI, Roehrborn CG, Kattan MW. An updated catalog of prostate cancer predictive tools. Cancer. 2008;113:3075-99.
  16. Louie KS, Seigneurin A, Cathcart P, Sasieni P. Do prostate cancer risk models improve the predictive accuracy of PSA screening? A meta-analysis. Ann Oncol. 2015;26:848-64.
  17. Thompson IM, Ankerst DP, Chi C, Lucia MS, Goodman PJ, Crowley JJ, et al. Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA. 2005;294:66-70.
  18. Kolonel LN. Fat, meat, and prostate cancer. Epidemiol Rev. 2001;23:72-81.
  19. Oesterle S, Hill KG, Hawkins JD, Guo J, Catalano RF, Abbott RD. Adolescent heavy episodic drinking trajectories and health in young adulthood. J Stud Alcohol. 2004;65:204-12.
  20. Sierksma A, Sarkola T, Eriksson CJ, van der Gaag MS, Grobbee DE, Hendriks HF. Effect of moderate alcohol consumption on plasma dehydroepiandrosterone sulfate, testosterone, and estradiol levels in middle-aged men and postmenopausal women: a diet-controlled intervention study. Alcohol Clin Exp Res. 2004;28:780-5.
  21. Poschl G, Seitz HK. Alcohol and cancer. Alcohol Alcohol. 2004;39:155-65.
  22. Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A metaanalysis of alcohol drinking and cancer risk. Br J Cancer. 2001;85:1700-5.
  23. Dennis LK. Meta-analysis for combining relative risks of alcohol consumption and prostate cancer. Prostate. 2000;42:56-66.
  24. Rohrmann S, Linseisen J, Key TJ, Jensen MK, Overvad K, Johnsen NF, et al. Alcohol consumption and the risk for prostate cancer in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev. 2008;17:1282-7.
  25. Schoonen WM, Salinas CA, Kiemeney LA, Stanford JL. Alcohol consumption and risk of prostate cancer in middle-aged men. Int J Cancer. 2005;113:133-40.
  26. Bae JM, Li ZM, Shin MH, Kim DH, Lee MS, Ahn YO. Cigarette smoking and prostate cancer risk: negative results of the Seoul Male Cancer Cohort Study. Asian Pac J Cancer Prev. 2013;14:4667-9.
  27. Sawada N, Inoue M, Iwasaki M, Sasazuki S, Yamaji T, Shimazu T, et al. Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: the Japan Public Health Center-based prospective study. Int J Cancer. 2014;134:971-8.
  28. Rohrmann S, Linseisen J, Allen N, Bueno-de-Mesquita HB, Johnsen NF, Tjonneland A, et al. Smoking and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2013;108:708-14.
  29. Iribarren C, Tekawa IS, Sidney S, Friedman GD. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. N Engl J Med. 1999;340:1773-80.
  30. Platz EA, Leitzmann MF, Rimm EB, Willett WC, Giovannucci E. Alcohol intake, drinking patterns, and risk of prostate cancer in a large prospective cohort study. Am J Epidemiol. 2004;159:444-53.