Prevalence of incidental prostate cancer in the general population: a study of healthy organ donors

PURPOSE: The incidence of prostate cancer has surged dramatically in recent years due to improved cancer screening and detection mechanisms. There has also been significant interest specifically pertaining to the increased incidence of prostate cancer in younger males, which might be due to increased screening. We analyzed our data set of incidental prostate cancer, derived from a project accruing prostate tissues for research from normal organ donors, who are a predominantly white population. MATERIALS AND METHODS: Information about any prior prostate cancer screening in this cohort was not available. In addition, this population had no history of intervention related to benign or malignant prostate disease. The case cohort consisted of 340 prostates harvested for research from organ donors who died suddenly from August 1994 to April 2007. Stroke, motor vehicle accident, homicidal and suicidal gunshot wound to the head, cardiorespiratory arrest and trauma accounted for more than 90% of the causes of death in donors. RESULTS: Evaluation of serially sectioned prostate tissues revealed adenocarcinoma with or without high grade prostate intraepithelial neoplasia in 12% of cases. High grade prostate intraepithelial neoplasia alone occurred in 10.6% of donors. There was an age dependent increase in high grade prostate intraepithelial neoplasia starting from the 4th decade of life. Prostate adenocarcinoma escalated from the 5th decade and thereafter with a 1 in 3 chance of carrying incidental cancer in the 60 to 69-year-old age group and with 46% of 70 to 81-year-old men harboring prostate cancer. CONCLUSIONS: This study provides insight into the prevalence of prostate adenocarcinoma and high grade prostate intraepithelial neoplasia in the general healthy population. Associated issues, such as the age at which to start screening for prostate cancer and donor transmitted malignancy, were also discussed.