Baseline prostate inflammation is associated with a reduced risk of prostate cancer in men undergoing repeat prostate biopsy: Results from the REDUCE study

Abstract

BACKGROUND The current study was performed to evaluate whether baseline acute and chronic prostate inflammation among men with an initial negative biopsy for prostate cancer (PCa) increased the risk of subsequent PCa detection in a clinical trial with systematic biopsies. METHODS A retrospective analysis was performed of 6238 men aged 50 years to 75 years with prostate‐specific antigen levels between 2.5 ng/mL and 10 ng/mL and a prior negative biopsy in the REduction by DUtasteride of PCa Events study who completed a 2‐year biopsy. PCa, acute prostate inflammation, and chronic prostate inflammation were assessed by central review. The association between inflammation in baseline prostate biopsies and positive 2‐year and 4‐year repeat biopsies was evaluated with the chi‐square test and logistic regression analysis adjusting for baseline covariates. RESULTS Acute and chronic inflammation and both were detected in 46 baseline biopsies (1%), 3931 baseline biopsies (63%), and 892 baseline biopsies (14%), respectively. Acute and chronic inflammation were found to be significantly associated with each other (P < .001). Acute inflammation at baseline biopsy was associated with younger age, lower prostate‐specific antigen levels, and a smaller prostate (all P < .01), whereas chronic inflammation was associated with older age and larger prostate glands (all P < 0.01). At the 2‐year biopsy, the prevalence of PCa was 14% (N = 900 patients). On univariable and multivariable analysis, both acute and chronic inflammation were found to be significantly associated with a lower PCa risk (acute univariable: odds ratio [OR], 0.65 [P < .001] and multivariable: OR, 0.75 [P = .012] and chronic univariable: OR, 0.61 [P < .001] and multivariable: OR, 0.65 [P < .001]). At the time of 4‐year biopsy, only acute inflammation was found to be associated with a lower PCa risk. CONCLUSIONS Baseline acute and chronic inflammation were both found to be independently associated with a lower PCa risk. From a clinical standpoint, inflammation in negative biopsies for PCa may lower the risk of subsequent PCa detection. Cancer 2014;120:190–196. © 2013 American Cancer Society.

The association between prostatitis and prostate cancer. Systematic review and meta-analysis

“…Moreover, it has been demonstrated that the distribution of prostatic inflammation is similar for patients with and without chronic prostatitislike symptoms (36). However, histological chronic inflammation has been associated to increased prostate cancer risk in several studies (e.g., 37), though this issue is controversial, as other studies have shown that inflammation may actually decrease the risk for prostate cancer (38)(39)(40). Thus, from our point of view clinical, symptomatic chronic prostatitis and histological evidence of chronic inflammation of the prostate should be provisionally investigated as separate entities, whose impact on prostatic oncogenesis may be based on distinct mechanisms of action at the tissue, cellular or molecular levels.…”

Smoking Is Associated with Acute and Chronic Prostatic Inflammation: Results from the REDUCE Study

“…For instance, several authors have demonstrated positive correlation between urogenital infection, prostatitis, and sexually transmitted disease with prostate cancer (4,38,40). Conversely, more recent data suggest histologic inflammation in the biopsy specimen may actually be associated with decreased risk of prostate cancer detection in (19,(41)(42)(43). Similarly, a meta-analysis of 24 cohort studies found an association between active smoking and prostate cancer risk (44).…”

“…Multivariable logistic regression models were used to determine the association between smoking and prostate inflammation adjusting for baseline characteristics, such as age (continuous, in years), race (Caucasian, African American, Asian, American Hispanic, or other), body mass index (BMI, continuous and logtransformed, in kg/m 2 ), digital rectal exam (DRE, coded as normal or abnormal), PV (continuous and log-transformed, in cm 3 ), PSA (continuous, in ng/mL) to test the association of smoking status and baseline prostate inflammation. The selection of covariates in multivariable models was based on their observed and/or previously established associations with baseline smoking status and/or inflammation (19). The analysis of smoking and inflammation at 2-and 4-year biopsies was adjusted for treatment arm as well.…”

Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV prostatitis? A systematic literature review

“…11,13 Whether data of EPS-proven prostatic inflammation and biopsy-proven prostatitis should be combined may therefore be subject of debate. Inflammation upon first biopsy reduces the odds of prostate cancer in repeat biopsies, 21 presumably reflecting an elevated PSA as a result of inflammation. Only one of the included studies included men based upon biopsy results; therefore the outcome of this review mainly reflects findings in men with EPS-proven prostatitis.…”