REPLY BY THE AUTHORS: Comment on Polygamy, Sexual Behavior in a Population Under Risk for Prostate Cancer Diagnostic: An Observational Study From the Black Sea Region in Turkey

Abstract

To the editor, We thank Özkidik et al. for their interest and for their letter to the Editor (1). I will try to answer the questions they raised. The authors do not think it is possible for all patients to have similar lifestyles and nutritional habits. It is only possible to ensure all conditions are equal with animal studies. In animal model studies, animals are housed in cages in the same place, fed with the same feed and water, creating an ideal environment. However, when working with humans, such an implementation does not comply with the reality of life. As stated in our paper, our region receives nearly no migration from other areas. Most people in the region have lived here for at least three generations. The culture, lifestyle and nutritional habits have been shaped by the climatic conditions, plant cover and geographic structure of the region. As this is not a place where people from different cultures migrate and live together like in metropolitan areas, the lifestyles and nutritional habits of people in the region are naturally similar. It is not possible to perform a study similar to animal models, but our region is close to ideal due to similar lifestyles and nutritional habits in the region. The authors report it will be beneficial to state previous urethritis and prostatitis attacks. It should not be forgotten that urethritis and prostatitis are not diseases that always provide clinical findings. The PCPT study identified inflammation in 52.1% of samples from patients with biopsy performed (2). Similarly, some sexually transmitted diseases may be asymptomatic and therefore underreported (3). These infectious agents may maintain their presence latently especially in women. Similarly, they may not always cause clinical symptoms in males but may remain latent. As a result, the number of prostatitis and urethritis attacks patients suffered will not reflect the true infection rates. On the other hand, our study was not a study designed to reveal the cause-outcome relationship. It is an observational study. The results of our study identified that those with higher partner numbers had higher incidence of prostate cancer. The reason for this may be previous urethritis and prostatitis attacks, just as there may be other causes. It is necessary to design different studies to reveal the cause-outcome correlations about this topic.