04 Jan Link Between Prostatitis and Prostate Cancer Varies By Race
Dr. Benjamin Rybicki
MedicalResearch.com Interview with:
Benjamin A. Rybicki, Ph.D
Department of Public Health Sciences
Henry Ford Health System
Detroit, MI
Medical Research: What is the background for this study? What are the main findings?
Dr. Rybicki: Inflammation of the prostate gland—prostatitis—is a complex and heterogeneous condition. Two separate meta-analyses have estimated about a 60% increased risk of prostate cancer associated with clinical prostatitis. Most prostatitis, however, is asymptomatic and not fully captured in prevalence surveys. In fact, over 50% of surgical prostate specimens demonstrate some histological evidence of chronic inflammation, which has been generally shown to decrease risk of prostate cancer. The race of a patient may also be a factor as far as how inflammation influences prostate cancer risk. African American men are at greater risk for prostate cancer and demonstrate higher levels of circulating prostate specific antigen (PSA), which can confound the relationship between inflammation and prostate cancer.
In adjusted analyses, African American men with clinical chronic prostatitis had a significant 53% decreased risk of prostate cancer compared with African American men without prostatitis. Clinical prostatitis did not significantly increase prostate cancer risk in white men overall, but it was associated with a significant 3.5-fold increased risk in those who had no evidence of histologic prostatic inflammation. In addition, the investigators found that clinical prostatitis increased prostate cancer risk nearly 3-fold in white men with a low PSA velocity and nearly 2-fold in white men with more frequent PSA testing. PSA level and PSA density did not significantly modify the effect of clinical prostatitis on prostate cancer risk.
Medical Research: What should clinicians and patients take away from your report?
Dr. Rybicki: That not all prostatic inflammation is the same, and that inflammation should be evaluated by both patient report of symptoms and if possible, histologically by prostate biopsy. A thorough analysis of histologic inflammation by cell type and area of inflammation with respect to prostate glands can help in determining the likelihood of subsequent prostate cancer. Finally, the race of the patient should be taken into consideration when trying to relate how prostatic inflammation might influence prostate cancer risk.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Rybicki: Prostatitis is a biologically and clinically heterogeneous condition; as a result, determining its role in prostate carcinogenesis is challenging. Since clinically-reported prostatitis is more likely when the underlying prostatic inflammation is extensive, the factors that influence the spread of prostatic inflammation, and how these factors may promote carcinogenesis need to be better understood. Epidemiologic studies of prostatitis must also consider detection bias and how to best correct for it given the link between prostatic inflammation and elevated PSA, which increases screening intensity for prostate cancer. Further dissection of inflammatory phenotypes on the molecular level may ultimately be necessary to determine which inflammatory conditions of the prostate increase cancer risk.
Citation:
Prostate Cancer Prostatic Dis. 2015 Dec 1. doi: 10.1038/pcan.2015.54. [Epub ahead of print]
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Benjamin A. Rybicki, Ph.D (2016). Link Between Prostatitis and Prostate Cancer Varies By Race MedicalResearch.com
Last Updated on January 4, 2016 by Marie Benz MD FAAD