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Basic Research

Racial differences in the relationship between clinical prostatitis, presence of inflammation in benign prostate and subsequent risk of prostate cancer

Prostate Cancer and Prostatic Diseases volume 19, pages 145–150 (2016)Cite this article

Subjects

Abstract

Background:

Epidemiologic studies, primarily done in white men, suggest that a history of clinically-diagnosed prostatitis increases prostate cancer risk, but that histological prostate inflammation decreases risk. The relationship between a clinical history of prostatitis and histologic inflammation in terms of how these two manifestations of prostatic inflammation jointly contribute to prostate cancer risk and whether racial differences exist in this relationship is uncertain.

Methods:

Using a nested design within a cohort of men with benign prostate tissue specimens, we analyzed the data on both clinically-diagnosed prostatitis (NIH categories I–III) and histological inflammation in 574 prostate cancer case-control pairs (345 white, 229 African American).

Results:

Clinical prostatitis was not associated with increased prostate cancer risk in the full sample, but showed a suggestive inverse association with prostate cancer in African Americans (odds ratio (OR)=0.47; 95% confidence interval (CI)=0.27–0.81). In whites, clinical prostatitis increased risk by 40%, but was only associated with a significant increased prostate cancer risk in the absence of evidence of histological inflammation (OR=3.56; 95% CI=1.15–10.99). Moreover, PSA velocity (P=0.008) and frequency of PSA testing (P=0.003) were significant modifiers of risk. Clinical prostatitis increased risk of prostate cancer almost three-fold (OR=2.97; 95% CI=1.40–6.30) in white men with low PSA velocity and about twofold in white men with more frequent PSA testing (OR=1.91; 95% CI=1.09–3.35).

Conclusions:

In our cohort of men with benign prostate specimens, race, and histological inflammation were important cofactors in the relationship between clinical prostatitis and prostate cancer. Clinical prostatitis was associated with a slightly decreased risk for prostate cancer in African American men. In white men, the relationship between clinical prostatitis and prostate cancer risk was modified by histological prostatic inflammation, PSA velocity, and frequency of PSA testing—suggesting a complex interplay between these indications of prostatic inflammation and prostate cancer detection.

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References

  1. Theodorou C, Becopoulos T . Prostatitis. Prostate Cancer Prostatic Dis 1999; 2: 234–240.

    Article  PubMed  Google Scholar 

  2. Krieger JN, Nyberg L Jr, Nickel JC . NIH consensus definition and classification of prostatitis. JAMA 1999; 282: 236–237.

    Article  CAS  PubMed  Google Scholar 

  3. Nickel JC, True LD, Krieger JN, Berger RE, Boag AH, Young ID . Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU Int 2001; 87: 797–805.

    Article  CAS  PubMed  Google Scholar 

  4. Roberts RO, Lieber MM, Rhodes T, Girman CJ, Bostwick DG, Jacobsen SJ . Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Urology 1998; 51: 578–584.

    Article  CAS  PubMed  Google Scholar 

  5. Wu C, Zhang Z, Lu Z, Liao M, Zhang Y, Xie Y et al. Prevalence of and risk factors for asymptomatic in fl ammatory (NIH-IV) prostatitis in Chinese men. PLoS One 2013; 8: e71298.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dennis LK, Lynch CF, Torner JC . Epidemiologic association between prostatitis and prostate cancer. Urology 2002; 60: 78–83.

    Article  PubMed  Google Scholar 

  7. Jiang J, Li J, Yunxia Z, Zhu H, Liu J, Pumill C . The role of prostatitis in prostate cancer: meta-analysis. PLoS One 2013; 8: e85179.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cheng I, Witte JS, Jacobsen SJ, Haque R, Quinn VP, Quesenberry CP et al. Prostatitis, sexually transmitted diseases, and prostate cancer: the California Men's Health Study. PLoS One 2010; 5: e8736.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Roberts RO, Bergstralh EJ, Bass SE, Lieber MM, Jacobsen SJ . Prostatitis as a risk factor for prostate cancer. Epidemiology 2004; 15: 93–99.

    Article  PubMed  Google Scholar 

  10. Nickel JC, Downey J, Hunter D, Clark J . Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol 2001; 165: 842–845.

    Article  CAS  PubMed  Google Scholar 

  11. Rizzo M, Marchetti F, Travaglini F, Trinchieri A, Nickel JC . Prevalence, diagnosis and treatment of prostatitis in Italy: a prospective urology outpatient practice study. BJU Int 2003; 92: 955–959.

    Article  CAS  PubMed  Google Scholar 

  12. Lipsky BA, Byren I, Hoey CT . Treatment of bacterial prostatitis. Clin Infect Dis 2010; 50: 1641–1652.

    Article  PubMed  Google Scholar 

  13. Delongchamps NB, de la RG, Chandan V, Jones R, Sunheimer R, Threatte G et al. Evaluation of prostatitis in autopsied prostates—is chronic inflammation more associated with benign prostatic hyperplasia or cancer? J Urol 2008; 179: 1736–1740.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kryvenko ON, Jankowski M, Chitale DA, Tang D, Rundle A, Trudeau S et al. Inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer. Mod Pathol 2012; 25: 1023–1032.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Terakawa T, Miyake H, Kanomata N, Kumano M, Takenaka A, Fujisawao M . Inverse association between histologic inflammation in needle biopsy specimens and prostate cancer in men with serum PSA of 10-50 ng/ml. Urology 2008; 72: 1194–1197.

    Article  PubMed  Google Scholar 

  16. Karakiewicz PI, Benayoun S, Begin LR, Duclos A, Valiquette L, McCormack M et al. Chronic inflammation is negatively associated with prostate cancer and high-grade prostatic intraepithelial neoplasia on needle biopsy. Int J Clin Pract 2007; 61: 425–430.

    Article  CAS  PubMed  Google Scholar 

  17. Lee AG, Choi YH, Cho SY, Cho IR . A prospective study of reducing unnecessary prostate biopsy in patients with high serum prostate-specific antigen with consideration of prostatic inflammation. Korean J Urol 2012; 53: 50–53.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gurel B, Lucia MS, Thompson IM Jr, Goodman PJ, Tangen CM, Kristal AR et al. Chronic inflammation in benign prostate tissue is associated with high-grade prostate cancer in the placebo arm of the prostate cancer prevention trial. Cancer Epidemiol Biomarkers Prev 2014; 23: 847–856.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhao C, Venigalla S, Miyamoto H . Chronic inflammation on initial benign prostate biopsy is a negative predictor of subsequent cancer detection. Pathol Int 2012; 62: 774–776.

    Article  PubMed  Google Scholar 

  20. Fujita K, Hosomi M, Tanigawa G, Okumi M, Fushimi H, Yamaguchi S . Prostatic inflammation detected in initial biopsy specimens and urinary pyuria are predictors of negative repeat prostate biopsy. J Urol 2011; 185: 1722–1727.

    Article  PubMed  Google Scholar 

  21. Yli-Hemminki TH, Laurila M, Auvinen A, Maattanen L, Huhtala H, Tammela TL et al. Histological inflammation and risk of subsequent prostate cancer among men with initially elevated serum prostate-specific antigen (PSA) concentration in the Finnish prostate cancer screening trial. BJU Int 2013; 112: 735–741.

    Article  CAS  PubMed  Google Scholar 

  22. Moreira DM, Nickel JC, Gerber L, Muller RL, Andriole GL, Castro-Santamaria R et al. Baseline prostate inflammation is associated with a reduced risk of prostate cancer in men undergoing repeat prostate biopsy: results from the REDUCE study. Cancer 2014; 120: 190–196.

    Article  CAS  PubMed  Google Scholar 

  23. DeSantis C, Naishadham D, Jemal A . Cancer statistics for African Americans, 2013. CA Cancer J Clin 2013; 63: 151–166.

    Article  PubMed  Google Scholar 

  24. Henderson RJ, Eastham JA, Culkin DJ, Kattan MW, Whatley T, Mata J et al. Prostate-specific antigen (PSA) and PSA density: racial differences in men without prostate cancer. J Natl Cancer Inst. 1997; 89: 134–138.

    Article  CAS  PubMed  Google Scholar 

  25. Tewari A, Horninger W, Badani KK, Hasan M, Coon S, Crawford ED et al. Racial differences in serum prostate-specific antigen (PSA) doubling time, histopathological variables and long-term PSA recurrence between African-American and white American men undergoing radical prostatectomy for clinically localized prostate cancer. BJU Int 2005; 96: 29–33.

    Article  PubMed  Google Scholar 

  26. Kwak C, Ku JH, Kim T, Park DW, Choi KY, Lee E et al. Effect of subclinical prostatic inflammation on serum PSA levels in men with clinically undetectable prostate cancer. Urology 2003; 62: 854–859.

    Article  PubMed  Google Scholar 

  27. Fowler JE Jr, Bigler SA, Kilambi NK, Land SA . Relationships between prostate-specific antigen and prostate volume in black and white men with benign prostate biopsies. Urology 1999; 53: 1175–1178.

    Article  PubMed  Google Scholar 

  28. Eastham JA, May RA, Whatley T, Crow A, Venable DD, Sartor O . Clinical characteristics and biopsy specimen features in African-American and white men without prostate cancer. J Natl Cancer Inst 1998; 90: 756–760.

    Article  CAS  PubMed  Google Scholar 

  29. Sarma AV, McLaughlin JC, Wallner LP, Dunn RL, Cooney KA, Schottenfeld D et al. Sexual behavior, sexually transmitted diseases and prostatitis: the risk of prostate cancer in black men. J Urol 2006; 176: 1108–1113.

    Article  PubMed  Google Scholar 

  30. John EM, Whittemore AS, Wu AH, Kolonel LN, Hislop TG, Howe GR et al. Vasectomy and prostate cancer: results from a multiethnic case-control study. J Natl Cancer Inst 1995; 87: 662–669.

    Article  CAS  PubMed  Google Scholar 

  31. Patel DA, Bock CH, Schwartz K, Wenzlaff AS, Demers RY, Severson RK . Sexually transmitted diseases and other urogenital conditions as risk factors for prostate cancer: a case—control study in Wayne County, Michigan. Cancer Causes Control 2005; 16: 263–273.

    Article  PubMed  Google Scholar 

  32. Gui-Zhong L, Libo M, Guanglin H, Jianwei W . The correlation of extent and grade of inflammation with serum PSA levels in patients with IV prostatitis. Int Urol Nephrol 2011; 43: 295–301.

    Article  PubMed  Google Scholar 

  33. Ozden C, Ozdal OL, Guzel O, Han O, Seckin S, Memis A . The correlation between serum prostate specific antigen levels and asymptomatic inflammatory prostatitis. Int Urol Nephrol 2007; 39: 859–863.

    Article  CAS  PubMed  Google Scholar 

  34. Nickel JC . Lower urinary tract symptoms associated with prostatitis. Can Urol Assoc J 2012; 6 (5 Suppl 2): S133–S135.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nickel JC, Downey J, Young I, Boag S . Asymptomatic inflammation and/or infection in benign prostatic hyperplasia. BJU Int 1999; 84: 976–981.

    Article  CAS  PubMed  Google Scholar 

  36. Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE . Epidemiology of prostatitis. Int J Antimicrob Agents 2008; 31 (Suppl 1): S85–S90.

    Article  CAS  PubMed  Google Scholar 

  37. Welch HG, Fisher ES, Gottlieb DJ, Barry MJ . Detection of prostate cancer via biopsy in the Medicare-SEER population during the PSA era. J Natl Cancer Inst 2007; 99: 1395–1400.

    Article  PubMed  Google Scholar 

  38. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML . Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst 2011; 103: 117–128.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wallace TA, Prueitt RL, Yi M, Howe TM, Gillespie JW, Yfantis HG et al. Tumor immunobiological differences in prostate cancer between African-American and European-American men. Cancer Res 2008; 68: 927–936.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the medical record abstractors and other study personnel who assisted with the data collection and specimen preparation. We especially thank Travis Wheeler and Nancy Lemke for their work acquiring and staining prostate tissue specimens. NIH grant # 5R01-ES011126.

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Authors and Affiliations

  1. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    B A Rybicki, Y Wang, M Jankowski & S Trudeau

  2. Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA

    O N Kryvenko

  3. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA

    O N Kryvenko

  4. Department of Pathology, Henry Ford Health System, Detroit, MI, USA

    D A Chitale & N S Gupta

  5. Department of Epidemiology, Columbia University, New York, NY, USA

    A Rundle

  6. Department of Environmental Health Sciences, Columbia University, New York, NY, USA

    D Tang

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  1. B A Rybicki
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Correspondence to B A Rybicki.

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Rybicki, B., Kryvenko, O., Wang, Y. et al. Racial differences in the relationship between clinical prostatitis, presence of inflammation in benign prostate and subsequent risk of prostate cancer. Prostate Cancer Prostatic Dis 19, 145–150 (2016). https://doi.org/10.1038/pcan.2015.54

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