Chronic asymptomatic inflammation of the prostate type IV and carcinoma of the prostate: Is there a correlation? "Beyond the Abstract," by Paul F. Engelhardt, FEBU

BERKELEY, CA (UroToday.com) - The present study aimed at detecting correlations between chronic asymptomatic inflammation of the prostate type IV and prostate cancer in patients undergoing radical prostatectomy and surgery for BPH.

Methods

Histological evaluation: Paraffin-embedded tissue specimens from 139 consecutive patients were originally stained with hematoxylin and eosin. In all cases, all original hematoxylin and eosin stained sections were reviewed by the pathologist. To characterize inflammatory changes, inflammatory “hot spots” were defined according to the criteria published by Irani et al. with regard to the histological grade and aggressiveness of the inflammatory process: histological grade 0 and 1 were regarded as “non-inflammatory group,” histological grade 2 and 3 as “inflammatory group.” Carcinomas were graded as to the Gleason grading system. (Table 1) Preoperatively, the factors total PSA, cholesterol, triglycerides, uric acid, IPSS score, and body-mass index (BMI) were evaluated and recorded for all patients in a standardized way and were correlated to the histological findings of the “inflammatory group” and “non-inflammatory group.”

Results

Table 1: Characteristics of PCa and BPH groups

Table 2: Histologic grading and aggressiveness of inflammatory changes in PCa group vs. BPH group by the grading system proposed by Irani, et al.

Table 3: Correlation of inflammatory vs. non inflammatory-group with Gleason score and TNM stage in PCa group

Discussion

In summary, based on available research data, a definitive conclusion about a correlation between chronic asymptomatic prostatic inflammation and prostate cancer is impossible at present.

Goldstraw, et al. hypothesized that:

1. Without exact knowledge about the prevalence of asymptomatic chronic inflammation, a rate of 5 to 10% in men > 40 years is suggested.
2. Men with symptomatic chronic inflammation of the prostate are examined more frequently, thus prostate cancer may be diagnosed at a higher rate than in a healthy population.
3. The increased rate of chronic inflammation in patients undergoing surgery for benign prostatic hyperplasia may also be biased, since lower urinary tract symptoms (LUTS) are more present in these patients and urinary retention and subvesical obstruction may favour chronic inflammation and vice versa.

From present data, it seems plausible that in men with a genetic predisposition, prostate cancer may be promoted by chronic inflammation. On the other hand, prostatic growth may be induced by chronic inflammation: In a retrospective analysis of 3 942 men with BPH, chronic inflammation could be found in 43% of the study population by De Silvio, et al. They also found a high correlation between patients with increased prostate volume and chronic inflammation. Similar results were reported by Nickel, et al. Data from the MTOPS study also showed a correlation between prostatic inflammation, BPH progression, and urinary retention within a 4-year period.

Inflammation is frequently observed in BPH and also frequently observed in prostate cancer. In this particular cohort, inflammation was observed more frequently in the BPH cases, but this does not imply that inflammation doesn’t play a role in generating prostate cancer. Indeed, it is postulated that inflammation may play a role in each of these prostatic diseases. Furthermore, there might also be a bias in detection of chronic inflammation in the prostate cancer group due to the use of antibiotic therapy after prostate biopsy. Although we found chronic inflammation in 44% of the histologic evaluations of the prostate cancer group, we could not verify any correlation between histological inflammation and tumor grading or TNM stage.

Further we have to be aware that an examination of tissues at an endpoint at which surgical intervention is required may tell us little about the role of chronic inflammation in either disease process, since it represents a snapshot of the clinically manifest disease that took decades to develop. Nevertheless, at the moment of this “snapshot” we could not find any correlation or influence of chronic asymptomatic inflammation and the histological findings of the prostate carcinoma cohort.

The pathological features and variables discussed in this study were evaluated by a single pathologist with previous experience in the determination of inflammatory or immune cell infiltrates in tumors. However, an approach by several pathologists with the mention of inter-observer agreement may be beneficial to future studies on this matter.

There was not a difference in PSA values between inflammation and non-inflammation patients. Unexpectedly, PSA levels tended to be higher in the non-inflammatory subgroups, in malignant and benign disease. Maybe this is a fact due to the low number of patients, however results were not significant.

Our study results conform to published data: chronic asymptomatic prostatic inflammation was positively correlated with age and prostate volume. The present analysis is the first that prospectively compared inflammatory changes of the prostate, classified by the Irani system, in patients with prostate cancer and benign prostatic hyperplasia. No significant correlation between chronic inflammation and carcinoma of the prostate was detected. In contrast to expectations, a significantly higher score of inflammatory changes was found in BPH patients, and total PSA levels tended to be lower in the inflammatory group.

Written by:
Paul F. Engelhardt, FEBU as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Abt. f. Urologie und Andrologie
Thermenklinikum Baden-Mödling
Wimmergasse 19
A-2500 Baden
Austria

Chronic asymptomatic inflammation of the prostate type IV and carcinoma of the prostate: Is there a correlation? - Abstract

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