Environmental pollutants, particularly particulate matter (PM) air pollution, have been increasingly recognized for their significant impact on human health. Numerous studies have established a strong correlation between environmental pollution and various types of cancer, including lung, heart, brain, and respiratory diseases (1). Among these pollutants, fine dust, specifically PM₁₀, has been implicated in a range of diseases such as chronic obstructive pulmonary disease (COPD), asthma, and lung cancer (2–6). Fine dust penetrates deep into the lungs, causing inflammation and increasing the risk of lung cancer. Additionally, emerging research suggests that fine dust exposure may also contribute to the development of urological cancers, including kidney cancer, urothelial cell carcinoma, and prostate cancer (PCa) (7, 8). Some study have also found that renal function and chronic urologic diseases are associated with PM₁₀ (9, 10). There are also paper on the relationship between industrial pollution, including PM₁₀, and the risk of PCa (11). However, research on PCa and PM₁₀ is still needed, and diverse well-designed studies on PCa are needed. In addition, in Korea, there is a public DB on air quality (the Air Korea's annual average air quality database), so research using it is possible.

While various environmental standards for fine dust exist globally, these standards vary by country, reflecting local conditions. In Korea, the environmental standards for fine dust have adopted the second stage of the World Health Organization's (WHO) 2005 interim targets for air quality (12). According to the 2021 WHO recommendation, the PM₁₀ standard levels is 15 μg/m² for the annual average and 45 μg/m² for the 24-h average (12). However, in Korea, the PM₁₀ standard levels is 50 μg/m² for the annual average and 100 μg/m² for the 24-h average (13). Despite efforts to reduce fine dust levels through various policies, Korea's standard levels concentration remains high compared to that in developed countries.

PCa is a significant health concern, particularly in Korea, where it ranks third among cancers in men and sixth in overall cancer incidence as of 2021 (14). In Western countries such as Europe and the United States, it has been the number one cancer in men for a long time (15). PCa is rapidly increasing along with the increase in the aging population. Its importance is increasing in Korea, which is entering a super-aging society. PCa is a cancer with a good prognosis when detected early, with a high survival rate of more than 5 years. However, the social costs caused by PCa remain enormous.

Given the rising incidence of PCa and the ongoing concerns about environmental pollution, it is crucial to understand the potential role of fine dust exposure in the development of this cancer. Therefore, this study aimed to investigate the risk of PCa due to moderate level fine dust (31–80 μg/m²) concentration in Korea (13).

This study aimed to determine the risks associated with moderate levels of PM₁₀ exposure for the development of PCa, based on the fine dust standards of the Korean Ministry of Environment (13). The findings reveal several important insights.

First, we observed that even moderate levels (31–80 μg/m³, Korea standard) (13) of PM₁₀ exposure are significant risk factors for the development of PCa. According to the Korean air-quality classifications, a PM₁₀ level of 47 μg/m³ is considered moderate level, a level at which masks are typically not worn by the public (13). However, our findings suggest that even at these moderate levels, PM₁₀ exposure can influence the development of urological cancers such as PCa. This aligns with previous studies that have highlighted detrimental effects of PM₁₀ on cancer risk (7, 24). There is little research on moderate level PM₁₀, so in-depth discussion on it is limited. However, it is very meaningful that disease risks were predicted even for moderate level fine dust, even based on Korean standards.

In Korea, days with poor air quality have increased since 2012 due to an increase in PM, and various measures have been sought along with public concerns (9). Since 2015, air quality alerts have increased nationwide (25). Nevertheless, as described in the introduction, Korea PM₁₀ standards are less stringent than those in other countries. The PM₁₀ standard levels of 2021 WHO recommendation is 15 μg/m³ for the annual average and 45 μg/m³ for the 24-h average (12). The PM₁₀ standard levels is 50 μg/m³ for the annual average and 100 μg/m³ for the 24-h average in Korea (13). This study emphasizes that Korea should further strengthen air quality standards for PM₁₀.

In addition, it is critical to implement more detailed guidelines and actively promote the use of masks and air purification strategies when air quality deteriorates to hazardous levels. Prior research has demonstrated that education about the health risks associated with fine dust can influence public perceptions of susceptibility and severity (26). Our findings support the need for robust awareness campaigns to mitigate these risks.

Second, the study highlights the importance of individual physical characteristics in the relationship between PM₁₀ exposure and PCa development. We found that the risk of PCa due PM₁₀ exposure is higher in patients under 65 years of age, in those with suspected hypertension, in individuals with total cholesterol levels below 200 mg/dL, and in obese individuals. These findings contribute to the ongoing debate on the association between obesity, air pollution, and cancer risk (27). Previous research continues to explore the relationship between local environment factors and cancer incidence (28). Many studies have suggested that air pollution may negatively contribute to body weight status in adults (29–33), our results also indicate that in obesity, PM₁₀ exposure is a significant risk factor for PCa. Thus, identifying high-risk groups based on major factors such as underlying health conditions is crucial, and targeted mid- to long-term support for these groups should be prioritized.

Third, lifestyle habits also play a crucial role in the relationship between PM₁₀ exposure and PCa. Our study found that the risk of developing PCa due to PM₁₀ exposure is elevated in individuals who do not engage in regular exercise, in ex-smokers, and in those who consume alcohol three to four times a week. These results are consistent with previous research indicating that lifestyle management can help mitigate the incidence of cancer related to air pollution (7, 28, 34, 35). In order to reduce the social cost of cancer, a comprehensive solution approach is needed that addresses environmental issues such as air pollution and actively corrects people's lifestyle habits.

Finally, we observed that the risk of developing PCa due to PM₁₀ exposure was higher even in the presence of low PM_2.5. This result was very interesting because even when PM_2.5 is low, increased PM₁₀ exposure increases the risk of developing PCa. Both PM₁₀ and PM_2.5 are air quality measurements, and although they are very important air quality measurement factors and global challenge issues (36–40), they should be viewed separately. Depending on the disease, PM_2.5 and PM₁₀ exposure often affect the disease at the same time (40). In fact, there are days when PM_2.5 levels are low but PM₁₀ levels are high. Although it is important to understand the impact of the integrated air quality index or multiple pollutants together in some cases (41), the fact that PM₁₀ alone still increases the risk of disease is very significant.

Despite these significant findings, our study has several limitations. First, air pollution encompasses a range of pollutants, including PM₁₀, NO₂, and PM_2.5 (42), and the incidence of various cancers has been consistently linked to PM_2.5 exposure (43, 44). However, our study focused mainly on the relationship between PM₁₀ exposure and PCa. Future research should consider a broader range of air pollutants to provide a more comprehensive understanding of their combined effects. Second, the study limited the period of PM₁₀ exposure to 3 years (2010–2012). We used PM₁₀ exposure data from Air Korea's annual average air quality database. The Air Korea's annual average air quality database has been providing air quality data since 2009, we identified appropriate data for the study and used air quality data from 2010 to 2012, which provided the longest follow-up period. Therefore, we used only 3 years of data to select data with as many area codes as possible that can be matched with NHISS customized health information data and with PM₁₀ values that can be used in research. Additional research with longer exposure periods is needed to fully assess the long-term risks associated with fine dust exposure. Third, this study considered some lifestyle factors such as alcohol consumption, smoking, and physical activity. However, there may be other lifestyle factors, such as diet and occupational exposure, which could also influence the risk of prostate cancer. However, the customized health information data from NHISS does not provide additional lifestyle data (such as diet and occupational exposure), so it could not be utilized. Future research is needed to derive risk factors by including various lifestyles. Fourth, this study is based on Korea's environmental standards (13), and since environmental standards may differ from country to country, there may be limitations in the global applicability of the research results. Future research needs to be conducted based on global standards. Fifth, there is research that shows a relationship between air pollution and temperature (45). If we can secure data on temperature in the future, it would be desirable to analyze various environmental factors such as temperature in addition to air quality.

Despite these limitations, this study provides important insights into the relationship between moderate PM₁₀ exposure and increased PCa risk. The findings also underscore the need for more stringent and detailed environmental standards for PM₁₀. Reducing the disease risk from fine dust requires a mid- to long-term, comprehensive solution approach to identify high-risk groups and reduce social costs. In addition, public health should emphasize the importance of wearing masks and managing air quality, and managing lifestyle habits to protect the negative health effects of fine dust exposure.