Periodontal disease and the risk of prostate cancer: a meta-analysis of cohort studies

Abstract

Background: Periodontal disease is reportedly associated with the risk of various systemic diseases, including pancreatic and lung cancers. However, its association with prostate cancer remains inconclusive. Herein, we explored the association of periodontal disease with the risk of prostate cancer through a meta-analysis. Materials and Methods: MEDLINE, Embase, Web of Sciences and Cochrane Library databases were searched for eligible publications up to April 2020. Multivariate adjusted risk estimates with corresponding 95% confidence intervals (CIs) were extracted and calculated using random- or fixed-effect models. Results: Nine cohort studies involving 3.353 prostate cancer cases with 440.911 participants were identified and included in the meta-analysis. We found that periodontal disease significantly increased the risk of prostate cancer by 1.40-fold (hazard ratio [HR]=1.40, 95% CI: 1.16-1.70; P=0.001; I2=76.1%) compared with normal condition. Interestingly, the risk of developing prostate cancer was not significant in patients treated with periodontal therapy (HR=1.22, 95% CI: 0.86-1.73; P=0.272; I2=65.2%). The results of subgroup analyses were also consistent and significant when stratified by study design and follow-up period, whereas conflicting results were observed in periodontal disease ascertainment stratification. These findings were robust as indicated by sensitivity analyses. Conclusions: Periodontal disease was associated with the increased risk of prostate cancer, whereas no significant association was observed in patients treated with periodontal therapy. Hence, the awareness and importance for maintaining oral health should be improved, and the underlying mechanisms linking periodontal disease and prostate cancer should be fully explored in future research.

Oral Hygiene Practices and Awareness of Pregnant Women about the Effects of Periodontal Disease on Pregnancy Outcomes

“…This severe form of inflammation is called periodontitis [ 1 – 4 ]. Periodontal disease is prevalent in both developed and undeveloped countries, and it affects around 90% of the worldwide population [ 2 , 3 ]. Dental plaque is the main etiological factor for periodontal disease.…”

“…Periodontal bacteria, which is a constant potential source of infection, when it enters the bloodstream, causes activation of the immune cells. These activated cells produce cytokines (inflammatory biological signals) that have a highly adverse effect throughout the body system and have been linked to cardiovascular diseases, cerebrovascular diseases, peripheral arterial diseases, diabetes mellitus, and adverse pregnancy outcomes [ 2 , 4 – 6 ].…”

PD-L1 Up-Regulation in Prostate Cancer Cells by Porphyromonas gingivalis

“…Evidence indicates a link between periodontitis and systemic illness such as cardiovascular diseases, diabetes, adverse pregnancy outcomes and rheumatoid arthritis (RA) ( Cullinan et al., 2009 ). A correlation between periodontitis and cancer is also established; periodontitis is most consistently linked to increased risks of oral and esophageal cancers ( Fitzpatrick and Katz, 2010 ), but it is also associated with increased risks of other cancer types, such as prostate cancer ( Fitzpatrick and Katz, 2010 ; Lee et al., 2017b ; Guo et al, 2021 ; Wei et al, 2021 ). Among the numerous bacterial species that exist in the oral cavity, Porphyromonas gingivalis ( P. gingivalis ) is associated with severe forms of periodontitis ( Mysak et al., 2014 ).…”

Metagenomics studies for the diagnosis and treatment of prostate cancer

“…92 Several studies confirmed that dislocation of oral pathogenic bacteria that are established to be involved in oral inflammatory diseases, such as periodontitis might be linked to PC. 93,94 In this case, increasing C-reactive protein (CRP) and pro-inflammatory cytokines, for example, (Interleukins) IL-1, IL-6, and (Tumor Necrosis Factor)…”

“…In recent studies, it was revealed that the host's microbiome, especially the gut microbiome can affect the cancer therapy efficiency through key mechanisms, such as immunomodulation, degradation, translocation, and metabolism 92 . Several studies confirmed that dislocation of oral pathogenic bacteria that are established to be involved in oral inflammatory diseases, such as periodontitis might be linked to PC 93,94 . In this case, increasing C‐reactive protein (CRP) and pro‐inflammatory cytokines, for example, (Interleukins) IL‐1, IL‐6, and (Tumor Necrosis Factor) TNF may cause prostate inflammation, followed by damaging prostate epithelium that ultimately results in PSA release 95,96 .…”