ÂThe first concern is, should patients with initial biopsies showing no malignancy but showing chronic inflammation be followed more closely and perhaps re-biopsied more frequently?Â
April 6, 2006.
Researchers at Case Western Reserve University in Cleveland have evidence linking chronic inflammation in the prostate to a greater risk of developing prostate cancer. Results of repeat biopsies of prostate tissue over a five-year period from men who had abnormal serum prostate specific antigen (PSA) levels and/or digital rectal examinations (DRE) suggest that chronic inflammation may be a significant risk factor in the development of prostate cancer.
While connections between inflammation and prostate cancer have been shown at cellular and genetic levels in laboratory studies, no one had shown a relation between chronic prostate inflammation and the development of prostate cancer in men. This work was was led by Sanjay Gupta, Ph.D., assistant professor of urology at Case Western Reserve University in Cleveland, along with Greg MacLennan, M.D., associate professor of pathology.
Gupta and his co-workers examined the results of prostate needle biopsies from 177 men between ages 47 and 83 years who were at high risk for developing cancer based on either high PSA scores or abnormal DREs. Of the 177 men, 144 or 81 percent were found to have chronic prostate tissue inflammation.
When the scientists categorized the biopsies based on pathology, they found that of the 144 cases:
- 15 percent (22/144) had only inflammation
- 15 percent (22/144) had simple atrophy
- 39 percent (54/144) showed PAH/PIA (post-atrophic hyperplasia and/or proliferative inflammatory atrophy, which indicate evidence of chronic inflammation) lesions,
- eight percent, or 12/144, showed HGPIN Â high-grade prostate intraepithelial neoplasia, which is a precursor to prostate cancer.
About 20 percent, or 29/144, had cancer (adenocarcinoma) in the initial biopsies.
The researchers analyzed 84 subsequent biopsies performed within five years in patients who had initially shown chronic prostate inflammation. In the follow up, 29 new cancer cases were diagnosed: six occurred in patients in whom initial biopsies showed only chronic inflammation, 15 in patients with initial PAH/PIA lesions, along with eight in patients with chronic inflammation and other risk factors for cancer (high-grade prostate intraepithelial neoplasia and atypical small acinar proliferation that may have been cancerous).
In contrast, the researchers found only two cases  six percent  in the 33 patients without inflammation who went on to develop cancer, both of whom had other risk factors for cancer.
ÂWe observed a significant association between serum PSA and the degree of chronic inflammation, said Gupta, which was expected based on previous findings.
ÂThe first concern is, should patients with initial biopsies showing no malignancy but showing chronic inflammation be followed more closely and perhaps re-biopsied more frequently? Gupta said.
Gupta's group plans future studies that will be similar in design, but have a larger number of subjects.
This study was presented April 4 at the 97th Annual Meeting of the American Association for Cancer Research.
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