Inflammatory atrophy on prostate needle biopsies: is there topographic relationship to cancer?

Abstract

Introduction: Chronic inflammation of longstanding duration has been linked to the development of carcinoma in several organ systems. It is controversial whether there is any relationship of inflammatory atrophy to prostate cancer. It has been suggested that the proliferative epithelium in inflammatory atrophy may progress to high-grade prostatic intraepithelial neoplasia and/or adenocarcinoma. The objective of our study is to compare on needle prostate biopsies of patients showing cancer the topographical relation of inflammatory atrophy and atrophy with no inflammation to adenocarcinoma. Materials and Methods:The frequency and extent of the lesions were studied on 172 needle biopsies of patients with prostate cancer. In cores showing both lesions, the foci of atrophy were counted. Clinicopathological features were compared according to presence or absence of inflammation. Results: Considering only cores showing adenocarcinoma, atrophy was seen in 116/172 (67.44%) biopsies; 70/116 (60.34%) biopsies showed atrophy and no inflammation and 46/116 (39.66%) biopsies showed inflammatory atrophy. From a total of 481 cores in 72 biopsies with inflammatory atrophy 184/481 (38.25%) cores showed no atrophy; 166/481 (34.51%) cores showed atrophy and no inflammation; 111/481 (23.08%) cores showed both lesions; and 20/481 (4.16%) showed only inflammatory atrophy. There was no statistically significant difference for the clinicopathological features studied. Conclusion: The result of our study seems not to favor the model of prostatic carcinogenesis in which there is a topographical relation of inflammatory atrophy to adenocarcinoma.

Role of inflammasomes and their regulators in prostate cancer initiation, progression and metastasis

“…Furthermore, a 5-year followup study based on prostate needle biopsies established that chronic inflammation accounts for nearly 20% of prostate cancer development [9]. Another needle biopsy study revealed that there were less frequent associations between inflammatory atrophy and adenocarcinoma [10]. Nonetheless, inflammatory atrophy was found in about 40% of the adenocarcinoma cores in that study.…”

“…Other studies report no significant association between prostatic inflammatory atrophy (PIA) and prostate cancer development [11,12]. PIA can be diffuse or focal, and the detection of small focal changes occurring at the peripheral zone is challenging in needle biopsies [13]. This variability could also be due to the presence of other confounding factors, such as genetic, nutritional and hormonal factors, and previous usage of antibiotics and antiinflammatory drugs.…”

Inflammation, prostatitis, proliferative inflammatory atrophy: ‘Fertile ground’ for prostate cancer development?

“…In a previous section, we reported that two studies failed to establish a relationship between PIA and HGPIN/PCa findings (23,24). The fact that simple linear relationships were not at first ascertained should not discourage researchers from performing new studies using more sophisticated mathematical tools and models.…”

“…Billis and coworkers investigated the topographical relation of inflammatory or non-inflammatory atrophy with adenocarcinoma in 172 needle biopsies. The authors expected to observe higher frequencies of inflammatory atrophy in cores with evidence of adenocarcinoma, but failed to demonstrate any significant link between these lesions (24). Therefore, the hypothesis that cancer may stem from atrophy should not be based on a mere linear quantitative relationship between the extent of atrophic and cancer lesions, i.e., on the assumption that a higher number of atrophic glands linearly correlates with a higher probability of cancer findings in a given patient.…”

Pathology

“…The link between atrophy and /or inflammatory atrophy and prostate cancer is theoretically attractive but controversial (1)(2)(3)(4)(5)(6)(7)(8). It has been difficult to verify a clinical connection between the lesions.…”