Prostatitis, Sexually Transmitted Diseases, and Prostate Cancer: The California Men's Health Study

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Abstract

Background

Prostatitis and sexually transmitted diseases (STDs) have been positively associated with prostate cancer in previous case-control studies. However, results from recent prospective studies have been inconclusive.

Methodogy/Principal Findings

We investigated the association between prostatitis, STDs, and prostate cancer among African American, Asian American, Latino, and White participants of the California Men's Health Study. Our analysis included 68,675 men, who completed a detailed baseline questionnaire in 2002–2003. We identified 1,658 incident prostate cancer cases during the follow-up period to June 30, 2006. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals. Overall, men having a history of prostatitis had an increased risk of prostate cancer than men with no history (RR = 1.30; 95% CI: 1.10–1.54). Longer duration of prostatitis symptoms was also associated with an increased risk of prostate cancer ( P trend = 0.003). In addition, among men screened for prostate cancer (1 or 2 PSA tests), a non-significant positive association was observed between prostatitis and prostate cancer (RR = 1.10; 95% CI: 0.75–1.63). STDs were not associated with overall prostate cancer risk. In racial/ethnic stratified analysis, Latinos reporting any STDs had an increased risk of disease than those with no STDs (RR = 1.43; 95% CI: 1.07–1.91). Interestingly, foreign-born Latinos displayed a larger risk associated with STDs (RR = 1.87; 95% CI: 1.16–3.02) than U.S. born Latinos (RR = 1.15; 95% CI: 0.76–3.02).

Conclusion

In summary, results from this prospective study suggest that prostatitis and STDs may be involved in prostate cancer susceptibility. While we cannot rule out the possible influence of incidental detection, future studies are warranted to further investigate the role of infectious agents related to prostatitis and STDs in prostate cancer development.

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Most cited references 16

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Inflammation in prostate carcinogenesis.

Angelo M. De Marzo, Elizabeth A. Platz, Siobhan Sutcliffe … (2007)

About 20% of all human cancers are caused by chronic infection or chronic inflammatory states. Recently, a new hypothesis has been proposed for prostate carcinogenesis. It proposes that exposure to environmental factors such as infectious agents and dietary carcinogens, and hormonal imbalances lead to injury of the prostate and to the development of chronic inflammation and regenerative 'risk factor' lesions, referred to as proliferative inflammatory atrophy (PIA). By developing new experimental animal models coupled with classical epidemiological studies, genetic epidemiological studies and molecular pathological approaches, we should be able to determine whether prostate cancer is driven by inflammation, and if so, to develop new strategies to prevent the disease.

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Sexual behaviour, STDs and risks for prostate cancer

R B Hayes, L Pottern, John H Strickler … (2000)

A population-based case-control study was carried out among 981 men (479 black, 502 white) with pathologically confirmed prostate cancer and 1315 controls (594 black, 721 white). In-person interviews elicited information on sexual behaviour and other potential risk factors for prostate cancer. Blood was drawn for serologic studies in a subset of the cases (n = 276) and controls (n = 295). Prostate cancer risk was increased among men who reported a history of gonorrhoea or syphilis (odds ratio (OR) = 1.6; 95% confidence internal (CI) 1.2–2.1) or showed serological evidence of syphilis (MHA-TP) (OR = 1.8; 95% CI 1.0–3.5). Patterns of risk for gonorrhoea and syphilis were similar for blacks (OR = 1.7; 95% CI 1.2–2.2) and whites (OR = 1.6; 95% CI 0.8–3.2). Risks increased with increasing occurrences of gonorrhoea, rising to OR = 3.3 (95% CI 1.4–7.8) among subjects with three or more events (P trend= 0.0005). Frequent sexual encounters with prostitutes and failure to use condoms were also associated with increased risk. Syphilis, gonorrhoea, sex with prostitutes and unprotected sexual intercourse may be indicators of contact with a sexually transmissible factor that increases the risk of prostate cancer. © 2000 Cancer Research Campaign

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Epidemiologic association between prostatitis and prostate cancer.

Leslie Dennis, Charles Lynch, James Torner (2002)

To quantify the relationship between prostatitis and prostate cancer by pooling previous epidemiologic studies of this association. A comprehensive search for articles published through 2000 was performed, blinded reviews of each study were conducted, data were abstracted, and all such studies were pooled. In this meta-analysis, an increased risk was seen among men with a history of prostatitis (odds ratio = 1.6), particularly with population-based case-control studies (odds ratio = 1.8). Increased relative risk estimates were also seen among men with a history of syphilis and a history of gonorrhea. These associations with prostate cancer suggest that infections may represent one mechanism through which prostate cancer develops. However, causality is unclear, because recall bias and detection bias cannot be ruled out. Future cohort studies of prostate cancer should examine sexually transmitted infections, as well as other infections, as potential risk factors.

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Author and article information

Contributors

: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2010

Publication date (Electronic): 15 January 2010

Volume: 5

Issue: 1

Electronic Location Identifier: e8736

Affiliations

[1 ]Epidemiology Program, Cancer Research Center of Hawai'i, University of Hawai'i, Honolulu, Hawai'i, United States of America

[2 ]Department of Epidemiology and Biostatistics and Institute of Human Genetics, University of California San Francisco, San Francisco, California, United States of America

[3 ]Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States of America

[4 ]Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America

University of Cape Town, South Africa

Author notes

* E-mail: icheng@ 123456crch.hawaii.edu

Conceived and designed the experiments: IC JW SVDE. Analyzed the data: IC JW. Contributed reagents/materials/analysis tools: VQ BC SVDE. Wrote the paper: IC JW SJ RH VQ CQ BC SVDE.

Article

Publisher ID: 09-PONE-RA-10670R2

DOI: 10.1371/journal.pone.0008736

PMC ID: 2806913

PubMed ID: 20090948

SO-VID: c5c6e100-6113-4234-8e17-996a045098f4

Copyright © Cheng et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 28 May 2009

Date accepted : 21 December 2009

Page count

Pages: 9

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