Chronic inflamed prostate may predispose for cancer

Chronic prostatic inflammation may increase the chance that a man will develop prostate cancer, suggesting that men with inflammation on biopsy may need to be followed more closely and perhaps even re-biopsied more aggressively, even if there is no evidence of cancer.

Gregory T. MacLennan, MD, and colleagues at Case Western Reserve University, Cleveland, examined prostate needle biopsies from 177 patients who exhibited clinical parameters suspicious for malignancy. They found chronic inflammation in 144 (81%) of those cases.

Of those 144, 54 (39%) had post-atrophic hyperplasia/proliferative inflammatory atrophy (PAH/PIA), while 22 (15%) showed only inflammation, another 22 had simple atrophy, 29 (20%) had adenocarcinoma, 12 (8%) had high-grade prostatic intraepithelial neoplasia (HGPIN), and five (3%) had atypical small-acinar proliferation (ASAP).

Among the biopsies without inflammation, almost half (46%) had no diagnostic findings. Thirty percent showed adenocarcinoma, 9% had simple atrophy, an additional 9% had HGPIN, and the remaining 6% had ASAP.

Perhaps the most valuable finding came when the group examined repeat biopsies done within 5 years in patients with chronic inflammation. Almost 20% of those were found to have adenocarcinoma, including 15 (10%) with initial PAH/PIA lesions, seven (5%) with initial HGPIN lesions, six (4%) with chronic inflammation only, and one (1%) with initial ASAP.

Dr. MacLennan suggested that potential etiologic factors in the genesis of chronic prostatic inflammation include imbalanced diet, exposure to environmental pollutants, high testosterone levels, viral infection, or genetic predisposition.