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JNCI Journal of the National Cancer Institute 1991 83(17):1231-1235; doi:10.1093/jnci/83.17.1231
© 1991 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 83, No. 17, 1231-1235, September 4, 1991
© 1991 Oxford University Press

Low-Grade, Latent Prostate Cancer Volume: Predictor of Clinical Cancer Incidence?

Alice S. Whittemore*,1, Joseph B. Keller2, Rebecca Betensky3

1Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine Stanford, Calif.
2Departments of Mathematics and Mechanical Engineering, Stanford University Stanford, Calif.
3Department of Statistics, Stanford University Stanford, Calif.

*Correspondence to: Alice S. Whittemore, Ph.D., Department of Health Research and Policy, Stanford University School of Medicine, HRP Building, Room 113, Stanford, CA 94305–5092.

We hypothesize that each cell in lowgrade (Gleason grade 1–3) prostate cancer tissue is at risk of transformation into a cell which produces a highgrade (Gleason grade 4–5) clinical cancer after a short period of growth. As a consequence, the volume of low-grade, latent cancer tissue in the prostate glands of men at any age determines their incidence rate for high-grade, clinical cancer a few years later. Autopsy and incidence data for both white men and black men support this conclusion, with a tumor growth period of about 7 years. The transformation rate is similar for black men and for white men, about 0.024 high-grade cancers per year per cm3 of lowgrade latent cancer volume. Our hypothesis explains the infrequent occurrence of clinical cancer despite the high prevalence of latent cancer, the steep rise of clinical cancer incidence with age despite the slow rise of latent cancer prevalence with age, and the disparities in clinical cancer incidence among some populations despite their similar latent cancer prevalence. This hypothesis suggests that low-grade cancer volume is a critical determinant of clinical cancer risk. [J Natl Cancer Inst 83:1231–1235, 1991]


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