New insights and methodologies are needed to solve the many epidemiologic enigmas of prostate cancer.

There is a tremendous need for a comprehensive review of the many facets of the epidemiology of prostate cancer. For well over three decades, we have struggled to identify etiologic factors that might explain the almost 10-fold differences in the incidence and mortality of prostate cancer between various geographic and ethnic populations. These rate differences can change dramatically during population migration between the areas, suggesting that environmental or lifestyle factors may play a critical role in either initiating or promoting prostate cancer. However, little specific insight has been gained into identifying these etiologic factors or the mechanisms involved. We do not even know whether the important regional factors are carcinogenic or protective agents. Many suspected factors certainly have been suggested, but no conviction about an agent has been forthcoming. Therefore, simply continuing to apply present techniques may not yield the answers we are looking for or at least make it very difficult to build a compelling argument.