Chronic inflammation in benign prostate tissue is associated with high-grade prostate cancer in the placebo arm of the prostate cancer prevention trial

Abstract

Background: Chronic inflammation is hypothesized to influence prostate cancer development, although a definitive link has not been established.

Methods: Prostate cancer cases (N = 191) detected on a for-cause (clinically indicated) or end-of-study (protocol directed) biopsy, and frequency-matched controls (N = 209), defined as negative for cancer on an end-of-study biopsy, were sampled from the placebo arm of the Prostate Cancer Prevention Trial. Inflammation prevalence and extent in benign areas of biopsy cores were visually assessed using digital images of hematoxylin and eosin-stained sections. Logistic regression was used to estimate associations.

Results: Of note, 86.2% of cases and 78.2% of controls had at least one biopsy core (of three assessed) with inflammation in benign areas, most of which was chronic. Men who had at least one biopsy core with inflammation had 1.78 [95% confidence interval (CI), 1.04-3.06] times the odds of prostate cancer compared with men who had zero cores with inflammation. The association was stronger for high-grade disease (Gleason sum 7-10, N = 94; OR, 2.24; 95% CI, 1.06-4.71). These patterns were present when restricting to cases and controls in whom intraprostatic inflammation was the least likely to have influenced biopsy recommendation because their prostate-specific antigen (PSA) was low (<2 ng/mL at biopsy).

Conclusion: Inflammation, most of which was chronic, was common in benign prostate tissue, and was positively associated with prostate cancer, especially high grade. The association did not seem to be due to detection bias.

Impact: This study supports an etiologic link between inflammation and prostate carcinogenesis, and suggests an avenue for prevention by mitigating intraprostatic inflammation.

Figure 1

Scoring of chronic inflammation in prostate biopsy cores by severity (grade) and tissue compartment. All images are of benign areas obtained as screen shots from whole slide scanned images. A-C shows increasing severity of inflammation in the stroma; D-F shows increasing severity of intraepithelial inflammation; G-I shows increasing severity of intraluminal inflammation. A-F, original magnification × 100. G-I, original magnification × 200.

Figure 2

Association between at least one biopsy core with inflammation and total and high-grade prostate cancer overall and when restricting the analysis to cases and controls with lower PSA concentration (<2 ng/mL) at biopsy.