Prostatitis, sexually transmitted diseases, and prostate cancer: The California Men’s Health Study

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BACKGROUND: A growing body of evidence from population and experimental studies provide strong support for the role of inflammation in prostate carcinogenesis. A meta-analysis of 29 case-control studies reported any sexually transmitted disease (STD) to be associated with a 1.5-fold increased risk of prostate cancer. Recently, the first prospective study of prostatitis, STDs and prostate cancer was conducted by the Health Professionals Follow-up Study. Overall, no association between prostatitis, STDs, and prostate cancer risk was observed. Of note, men in this study have a low burden of STDs. To further investigate the role of prostatitis, STDs and prostate cancer risk, we conducted a prospective study of California Men’s Health Study, a cohort of 84,190 men from four racial/ethnic groups, who are members of Kaiser Permanente.
 >METHODS: Data on history of prostatitis, gonorhhea, syphilis, chlamydia, and herpes were obtained from baseline questionnaires. A total of 1,329 incident prostate cancer cases were available for analysis. Cox proportional hazards models were used to calculate multivariate adjusted relative risks (RR) and 95% confidence intervals (95% CI) for prostate cancer.
 >RESULTS: Differences in the history of prostatitis and any STD were observed across racial/ethnic groups. For history of prostatitis, the highest frequencies were observed among Whites followed by African-Americans, Latinos, and Asians. For history of STDs, the highest frequencies were observed among African-Americans followed by Whites, Latinos, and Asians. Across racial/ethnic groups, the history of prostatitis ranged from 7.1% to 3.2%, any STD from 65.2% to 19.6%, gonorrhea from 50.8% to 7.3%, syphilis from 5.4% to 1.5%, chlamydia from 8.2% to 1.1%, and herpes from 7.7% to 3.0%. Prostatitis was associated with a significant 1.3-fold increased risk of prostate cancer (95% CI: 1.10-1.61; P = 0.003). Overall, any STD was not significantly associated with prostate cancer (RR=1.09; 95% CI: 0.99-1.23; P = 0.078). Although evidence of heterogeneity was observed across racial/ethnic groups (P heterogeneity = 0.039), with a significant increased risk of any STD observed among Latinos (RR=1.66; 95% CI: 1.22-2.26; P = 0.001). Gonorrhea was significantly associated with prostate cancer among Latinos (RR=1.52; 95%CI: 1.07-2.16; P = 0.018). Syphilis was associated with a significant 1.4-fold increased risk of prostate cancer (95% CI: 1.08-1.98; P = 0.028).
 >CONCLUSIONS: Our study suggests that prostatitis and syphilis may increase the risk of prostate cancer, supporting the role of inflammation in prostate cancer development.