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Chronic
intraprostatic inflammation may lead to a greater risk of developing
prostate cancer
Chronic
intraprostatic inflammation may lead to a greater risk of developing
prostate cancer. In our study we 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. We categorized the biopsies based on pathology. 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 and 8 percent, or 12/144, showed HGPIN –
high-grade prostate intraepithelial neoplasia, which is a putative
precursor to prostate cancer. Twenty percent, or 29/144, had cancer (adenocarcinoma) in the initial biopsies.
In subsequent studies, 84 subsequent
biopsies performed
within five years in patients who had initially
shown chronic prostate inflammation were analyzed. 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 PIN and atypical small acinar
proliferation suspicious for malignancy). In contrast, we found
only two cases – 6 percent – in the 33 patients without inflammation
who went on to develop cancer,
both of whom had other risks factors for cancer.
The
findings of this study suggest that there is a strong association
between chronic prostatic inflammation and
the development of pre-malignant and malignant changes in prostatic
epithelium. The study raise
two concerns:should patients with initial biopsies showing no malignancy,
but showing chronic inflammation, be followed more closely and perhaps
re-biopsied more frequently and is it wise to recommend watchful waiting
to patients diagnosed with low-grade adenocarcinoma accompanied by chronic
inflammation.?
Bibliographical reference: Sanjay GuptaDepartment of Urology, Case Western Reserve University, Cleveland, Ohio
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