Histological inflammation and risk of subsequent prostate cancer among men with initially elevated serum prostate‐specific antigen (PSA) concentration in the Finnish prostate cancer screening trial

Abstract

Objective To assess whether histological signs of inflammation are associated with an increased risk of subsequent prostate cancer (PCa) in men with elevated serum prostate‐specific antigen (PSA) concentrations and benign initial biopsy. Materials and Methods Study subjects were men aged 54–67 years with an elevated PSA (≥4 ng/mL or 3–4 ng/mL and free to total PSA ratio ≤0.16 or positive digital rectal examination), but a benign biopsy result within the Finnish population‐based randomised screening trial for PCa, which started in 1996. A total of 293 prostate biopsies without PCa or suspicion of malignancy from the first screening round in the Tampere centre were re‐evaluated by a uropathologist to assess histological inflammation. Results of the subsequent screening rounds were obtained from the trial database and PCa diagnoses made outside the screening were obtained from the Finnish Cancer Registry. The median length of follow‐up was 10.5 years. Cox regression analysis was used to assess PCa risk after the initial benign biopsy. Results Histological inflammation was found in 66% of the biopsies. Subjects with inflammation at the biopsy had a slightly lower PCa risk in the second screening round (18 vs 27%, rate ratio 0.69, 95% confidence interval [CI] 0.35–1.34) relative to men without inflammation. In further follow‐up, the PCa risk remained nonsignificantly lower (hazard ratio [HR] 0.71, CI 0.46–1.10; P = 0.13). The risk was not appreciably affected by adjustment for age, PSA, prostate volume and family history of PCa (HR 0.67, CI 0.42–1.07; P = 0.092). Conclusions Histological inflammation in a prostate biopsy among men with an initial false‐positive screening test was not associated with an increased risk of subsequent PCa, but instead with a decreased risk which was of borderline significance. Inflammation in prostate biopsy is not a useful risk indicator in PCa screening.

Inverse Association of Prostatic Chronic Inflammation among Prostate Cancer Tumor Grade Groups: Retrospective Study of 738 Consecutive Cases Elected to a First Random Biopsy Set

“…The results of our study confirm our preceding findings [5-9] and support outcomes of several clinical investigations showing an inverse association between PCI and PCA risk [13-17]. Because of the selection criteria, our results are more close to clinical practice than other studies, which are biased by inclusion criteria [13, 14, 16, 17]. Moreover, our study showed that the presence of PCI was not an infrequent event, since it was detected in 1 out of 4 cases.…”

“…Clinical studies evaluating biopsy cores by histology have shown no association [13], positive association [14], or inverse association [15-17] between PCI and PCA. The results of our study confirm our preceding findings [5-9] and support outcomes of several clinical investigations showing an inverse association between PCI and PCA risk [13-17]. Because of the selection criteria, our results are more close to clinical practice than other studies, which are biased by inclusion criteria [13, 14, 16, 17].…”

Prevention of Prostate Cancer: Outcomes of Clinical Trials and Future Opportunities

“…Note that our results differ from two recent studies, one in the Finnish Prostate Cancer Screening Trial, 19 and one in REDUCE, 20 which found that men with a prior biopsy that was negative for prostate cancer had a reduced prostate cancer risk in the future if inflammation was present in their prior negative biopsy. The PCPT and these study populations are quite different: we did not restrict to men who had a prior negative biopsy.…”

Effect of green tea catechins in patients with high-grade prostatic intraepithelial neoplasia: Results of a short-term double-blind placebo controlled phase II clinical trial

“…Finally, a meta-analysis indicated that consumption of green tea may have a protective effect on PCa in Asian populations, suggesting that further prospective cohort studies are needed to obtain a definitive conclusion in this field, especially with regard to the protective role of green tea on PCa across different regions apart from Asia (20). It is known that inflammation plays an important role in the aetiology of prostate cancer (28). On the other hand, several in vitro and in vivo studies have shown that both green tea and their catechins may inhibit carcinogenesis during the initiation, promotion and progression stages through many mechanisms, including the antioxidant effects (29).…”