Associations of phthalates with prostate cancer among the US population

Reprod Toxicol. 2023 Mar:116:108337. doi: 10.1016/j.reprotox.2023.108337. Epub 2023 Jan 13.


Human exposure to harmful phthalates has raised global health concerns. According to cellular and molecular investigations, phthalates and their metabolites can promote prostate cancer (PCa). Despite being a prevalent cancer afflicting the global male population, the epidemiological association between phthalates and prostate cancer remains understudied. This work aims to investigate whether phthalate metabolites are related to prostate cancer. Moreover, we sought to understand whether their elevated concentrations are associated with increased serum concentrations of prostate-specific antigen (PSA), among non-prostate cancer interviewees. According to National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2010, we screened eligible men aged 20 years or older. Then, crude and multivariate regression models were constructed to assess the relationship. The phthalates significantly related to PCa were analyzed based on variables associated with PCa status and PSA. The molar sum ∑di-2-ethylhexyl phthalate (∑DEHP) was simultaneously associated with increased risk of PCa and increasing PSA concentrations. Among PCa-related phthalates, high molecular weight phthalate metabolites included mono-benzyl phthalate (MBzP) and three metabolites of DEHP. In summary, phthalates are potentially associated with prostate tumorigenesis in the US population. However, additional in-depth prospective studies in different ethnic groups are required to validate the causality between both.

Keywords: Cross-sectional survey; National Health and Nutrition Examination Survey; Phthalates; Prostate cancer; Prostate-specific antigen (PSA).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Environmental Exposure / adverse effects
  • Environmental Pollutants*
  • Humans
  • Male
  • Nutrition Surveys
  • Overweight / chemically induced
  • Phthalic Acids* / adverse effects
  • Prospective Studies
  • Prostate-Specific Antigen
  • Prostatic Neoplasms* / epidemiology


  • phthalic acid
  • Prostate-Specific Antigen
  • Phthalic Acids
  • Environmental Pollutants