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Under physiological conditions, the concentrations of zinc and citrate in prostatic fluid are exceptionally high, reaching hundreds to thousands of times those in blood plasma (approximately 500-fold for zinc and 4001500-fold for citrate) (107111)

The initiation period is characterized by gradually increasing oncogene-induced oxidative stress, which triggers enhanced antioxidant defense, frequently involving the upregulation of antioxidant genes regulated by nuclear factor erythroid 2-related factor 2 (NRF2)