Epidemiology and Androgen Metabolism among Men with P Ca in Asia

Dear All,

I had placed a write up on Cancer Statistics of Urological Cancers in India. Roy had placed a comment on that by asking a question why the incidence is higher in North East of India. In a review article published in IJU by us on Demography of P Ca in India, we had also observed that the incidence is reported as higher in North East of India. The why is not known as we do not have a detailed epidemiological study.

I am providing informations on Epidemiology of P Ca in Asian Men published in Nature Reviews of Urology, 2021 May Issue.

In 2013 and later in 2017 NCCN Asian Consensus for P Ca have mentioned that there are differences in the Genetic Makeup of P Ca among Asians as against Caucasians. These changes have now been attributed to variations in Single Nucleotide Polymorphisms (SNPs) between Orientals and Caucasians.

We are informed of the various side effects on prolonged administration of any form of ADT on CVS and off late considerable mention are being made regarding Dementia. It has been reported that these events could commence with a year of ADT therapy among Caucasians. But it has been reported and recorded that such events are unusual in Orientals and even on 3 or more years of administration such events are rare. This has been attributed to the genetic aspects of P Ca among Orientals.

I am providing some excerpts from the article published by Yao Zhu*, Dingwei Ye* et al (2021), Nature Reviews Urology, May Issue. (PDF provided)

I am sure we will benefit by the article and I would urge all who have access to nature Reviews of Urology read and understand this study.

With warm regards,



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  • Venugopal P
    Venugopal P
    09 May 2021 07:55:25 AM

    I am posting the Informations taken from the article mentioned


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  • Dr. Roy Chally
    Dr. Roy Chally
    13 May 2021 10:16:40 PM

    The incidence of indolent and clinical cancer is higher in the white race compare to Asians. Human development Index (is a composite measurement of national achievements in three subvariables, health, education and income — including life expectancy, schooling years and gross national income per capita) is a risk factor for the incidence of s cancer Prostate. Unlike in the white race obesity and smoking are not a risk factor in Asians. 

    The Asian emigrants in USA has a low incidence of CA Prostate but the first generation Asian Americans has a higher incidence. Highest incidence in white. 23, 37 and  58 per 100 000 respectively. Life style, diet and genetics are the reasons for the higher incidence in Asian Americans compared to Asians. 

    The metastatic incidence of cancer Prostate is around 25 to 44% in developing countries. In USA this 19% and in Japan it is less than 10%. Screening for cancer is the reason for low incidence of metastatic disease in developed nations. But the norms for screening in Asians should not be the same as for the white race. 

    The incidence of higher grade Prostate cancers is higher in Asians compared to the white race. Yet the Asians have a higher life expectancy compared to the whites. The androgen deprivation works better in Asians. 

    This is due to the genomic metabolic differences. 

    The ERSPC risk calculator generally overestimated the risk of prostate cancer in the East Asian population. This again due to racial genetic differences 


    The Pirads score in mpMRI has different significance for Asians compared to the white race. Studies are needed to find the significance of this  score in Asians. 

    According to The Cancer Genome Atlas (TCGA) taxonomy, which is based on seven important oncogenic drivers for prostate can- cer (ERG, ETV1, ETV4, FLI1, SPOP, FOXA1 and IDH1), 68.4% of prostate cancer in Chinese men and 61.6% of American prostate cancer could be attributed to one of the TCGA taxonomies

            Genomic studies show differences in Asian and Caucasian population. Besides the incidence of tumour suppressor genes, and many other genetic mutations in the genome influence the incidence and growth of Prostate cancer. This explains the racial differences in the incidence and behaviour of cancer in races. This is a very complex area for me to fully understand. 


         The druggable pathways in prostate cancer: the AR pathway, the PTEN–PI3K– AKT pathway, DDR, the cell cycle and lineage plasticity. This is the same in Asians and Caucasians. In Asians the AR pathway show a different response to castration compared to the Caucasians. 

          More genomic studies in the population and the cancer ( Prostate cancer is heterogenous) are  needed to provide personalised specific cancer care. This is going to be the future. 

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