Chronic Inflammation in Benign Prostate Tissue Is Related to the Presence of High Grade Prostate Cancer
B Gurel, MS Lucia, EA Platz, AM De Marzo, for the Biology of PCPT Investigators. Johns Hopkins University, Baltimore, MD; University of Colorado School of Medicine, Denver, CO; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Chronic inflammation may be crucial for the etiology of prostatic adenocarcinoma (CaP). If inflammation is part of the pathogenesis of this disease then it might be expected that prostates with adenocarcinoma would harbor more inflammation than prostates without adenocarcinoma.
Design: Cases (biopsy detected and centrally reviewed) and age frequency-matched controls, defined as negative for adenocarcinoma on an end-of-study biopsy, were selected using a nested case-control design from among participants in placebo arm of the Prostate Cancer Prevention Trial (PCPT). The PCPT (n= ∼18,000 men) determined whether finasteride, a 5-alpha reductase inhibitor, could reduce the period prevalence of adenocarcinoma over 7 years. All men were screened annually by PSA and DRE, and all men not diagnosed with adenocarcinoma during the study were offered an end-of-study biopsy. Cases consisted of 191 men, and controls were from 209 men. Microscope slides (1- 5 core biopsies for each man) were digitized and evaluated online after masking of adenocarcinoma and random benign areas to ensure blinding of the pathologist to case/control status. Inflammation was assessed using a modified National Institutes of Health (NIH) grading system and data were analyzed using logistic regression.
Results: Men who had at least one biopsy core positive for chronic inflammation (CI) (majority was chronic) had 1.79 (95% CI 1.06-3.04) times the risk of prostate cancer compared with no cores positive. The association was stronger for higher-grade (Gleason score 7-10; OR=2.41, 95% CI 1.17-4.95) disease than for lower-grade (Gleason score 6; OR=1.45, 95% CI 0.79-2.68) disease. Risk of prostate cancer (p-trend=0.05) and higher-grade disease (p-trend=0.02) increased with increasing percent of cores positive.
Conclusions: The presence of any CI in benign prostate tissue was positively and statistically significantly associated with adenocarcinoma, especially higher grade lesions (Gleason score 7-10). Additional studies to further examine a potential role for inflammation as a cofactor in overall and high-grade prostate cancer should help determine whether chronic inflammation present in benign tissue is a reaction to the presence of cancer, or, is related to the pathogenesis of prostate cancer.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 122, Monday Morning