ABSTRACT/SUMMARYSince the early 1950s when sexually transmitted infections (STIs) were first proposed as a possible risk factor for prostate cancer, numerous epidemiologic studies have been conducted.Initially, these studies were primarily small case-control studies with retrospective, self-reported assessment of a narrow range of STIs, typically either any STIs, or gonorrhea and syphilis.However, as new STIs have been discovered/recognized, new and better tests to detect histories of STIs have been developed, and new resources for prostate cancer research have been created, epidemiologic studies have expanded to include a wider range of STIs, and have moved towards more rigorous, prospective study designs and serologic assessment of STI histories. The results of these studies are reviewed and discussed, as well as possible new avenues of research, such asTrichomonas vaginalis infection and infections not typically considered to be sexually transmitted.
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EARLY HYPOTHESES FOR SEXUALLY TRANSMITTED INFECTIONS AND PROSTATE CANCEREarly hypotheses related to a sexually transmitted etiology of prostate cancer were initially motivated by contemporary, epidemiologic patterns of prostate cancer occurrence. In the early 1950s, Ravich and Ravich [1, 2] noted a higher prostate cancer prevalence among mainly uncircumcised non-Jewish than circumcised Jewish men, similar to patterns for penile cancer and cervical cancer among female partners of these men, leading them to propose that observed patterns might be explained by sexual transmission of a virus or other carcinogenic agent contained within the smegma of uncircumcised males. Subsequent investigators [3][4][5] further proposed additional hypotheses related to infection, sexual behavior, and sexual frustration to explain other contemporary patterns of prostate cancer occurrence by marital, paternal, and racial status. Together, these observations and hypotheses led to a series of investigations beginning in the early 1970s to examine possible associations between STIs and sexual behavior in relation to prostate cancer.
Selection of STIs
STI markers:Most early investigations of STIs and prostate cancer assessed either a history of any STIs or individual histories of gonorrhea and syphilis as markers or possibly vectors of the potentially causative STI or sexual behavior [6][7][8][9]. These STIs were likely selected because they were the most common, well-known, and symptomatic STIs at the time, making them also more readily assessed by self-report, medical record abstraction, or registry query.
Prostate inflammation:Other early studies focused specifically on gonorrhea because it frequently led to 4 secondary gonococcal prostatitis in the pre-and early-antibiotic era, and because prostate inflammation had previously been hypothesized as a cause of atrophy and subsequent prostate cancer ([9-11] and references therein). This inflammation-atrophy-prostate cancer hypothesis has since gained further support with the observation of morphological and epigenetic transitions betwe...