Prostate chronic inflammation type IV and prostate cancer risk in patients undergoing first biopsy set: Results of a large cohort study

Abstract

Objective: In prostate specimens, chronic inflammatory infiltrate (CII) type IV has been detected, but its association with prostate cancer (PCa) is controversial. The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set.

Methods: Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients. The study excluded patients who were in active surveillance, prostate specific antigen (PSA) ≥30 ng/mL, re-biopsies, incidental PCa after transurethral resection of the prostate (TURP), less than 14 cores or metastatic. Analysis of population and subpopulations (with or without PCa) was performed by statistical methods which included Mann-Whitney (U test), Kruskal-Wallis test, Chi-squared statistic, logistic regression. Multivariate logistic regression models predicting mean probability of PCa detection were established.

Results: PCa detection rate was 46.03%. Age, PSA, prostate volume (PV), prostate intraepithelial neoplasia (PIN) and CII were the significant independent predictors of PCa detection. PV (OR = 0.934) and CII (OR = 0.192) were both negative independent predictors. CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age, PSA and PV. The inverse association of CII with PCa does not necessary mean protection because of PSA confounding.

Conclusion: In a population of patients undergoing prostate first biopsy set, CII was a strong negative independent predictor of PCa detection. CII type IV should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.

Keywords: Biopsy Gleason score; Chronic inflammation; Prostate; Prostate biopsy; Prostate cancer; Prostate specific antigen; Prostate volume.

Figure 1

Prostate biopsy indications. PSA, increased serum prostate specific antigen values; DRE, abnormal digital rectal exam with normal PSA values; DRE+PSA, both DRE and increased PSA; IMG, abnormal prostate imaging with normal PSA values.

Figure 2

Associations of CII with PCa. CII, chronic inflammatory infiltrate; PCa, prostate cancer.

Figure 3

Probability risk curves stratified by CII of the six models which are reported in Table 3. (A) CII associated with age; (B) CII interacting with age; (C) CII associated with PSA; (D) CII interacting with PSA; (E) CII associated with PV; (F) CII interacting with PV. CII, chronic inflammatory infiltrate; PCa, prostate cancer; PSA, total prostate specific antigen; PV, prostate volume.

Figure 4

Schematic mechanistic diagram showing the potential cellular exchange of signaling pathways towards inflammation in prostate cancer; prostatic intraepithelial neoplasia (PIN).