Correlation between Prostatitis, Benign Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-analysis

Abstract

Background: No consensus has been reached on the definite associations among prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Hence, this meta-analysis was conducted to explore their triadic relation by summarizing epidemiological evidence. Methods: Systematical and comprehensive retrieval of online databases PubMed, PMC, EMBASE and Web of Science was performed to acquire eligible studies, up to April 1st, 2019. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to clarify their correlations. Results: A total of 42 studies were enrolled in the quality assessment and 35 were finally included in the meta-analyses. Among them, 27 studies were included to describe the association between prostatitis and PCa (OR=1.72, 95% CI=1.44-2.06, I² =90.1%, P<0.001). 21 studies presented significant evidence about the relation between BPH and PCa (OR=2.16, 95% CI=1.75-2.88, I²=97.1%, P<0.001). Due to the huge heterogeneity among studies, those with obvious outliers were excluded based on the Galbraith plots. Ultimately, 17 studies were screened out to assess the association between prostatitis and PCa (OR=1.59, 95% CI=1.48-1.70, I²=29.4%, P=0.123). Meanwhile, 8 studies were retained to evaluate the association between BPH and PCa (OR=3.10, 95% CI=2.87-3.35, I²=8.4%, P=0.365). As for the relation between prostatitis and BPH, a case-control study and a cohort study both supported that prostatitis could enhance the risk of BPH. Conclusions: Significant correlations were revealed among prostatitis, BPH and PCa. Prostatitis or BPH could lead to escalating risks of PCa. Meanwhile, people with a history of prostatitis might be more vulnerable to BPH.

Keywords: Benign prostatic hyperplasia; Epidemiological.; Meta-analysis; Prostate cancer; Prostatitis.

Figure 1

Flow diagrams of the literature selection process. (A) Prostatitis and PCa; (B) BPH and PCa; (C) Prostatitis and BPH.

Figure 2

Forest plots of association between prostatitis and PCa by analyzing all enrolled studies. (A) Overall analysis; (B) The subgroup analyses of ethnicity; (C) study design; (D) sample size.

Figure 3

Galbraith plot associated with funnel plot and sensitive analysis of the association between prostatitis and PCa. (A) Sensitive analysis before adjustment for heterogeneity; (B) Funnel plot before adjustment for heterogeneity; (C) Galbraith plot before adjustment for heterogeneity; (D) Sensitive analysis after adjustment for heterogeneity; (E) Funnel plot after adjustment for heterogeneity; (F) Galbraith plot after adjustment for heterogeneity.

Figure 4

Forest plots of association between prostatitis and PCa after adjustment for heterogeneity based on Galbraith plot associated with funnel plot and sensitive analysis. (A) Overall analysis; (B) The subgroup analyses of ethnicity; (C) study design; (D) sample size.

Figure 5

Forest plots of association between BPH and PCa by analyzing all enrolled studies. (A) Overall analysis; (B) The subgroup analyses of ethnicity; (C) study design; (D) sample size.

Figure 6

Galbraith plot associated with funnel plot and sensitive analysis of the association between BPH and PCa. (A) Sensitive analysis before adjustment for heterogeneity; (B) Funnel plot before adjustment for heterogeneity; (C) Galbraith plot before adjustment for heterogeneity; (D) Sensitive analysis after adjustment for heterogeneity; (E) Funnel plot after adjustment for heterogeneity; (F) Galbraith plot after adjustment for heterogeneity;

Figure 7

Forest plots of association between BPH and PCa after adjustment for heterogeneity based on Galbraith plot associated with funnel plot and sensitive analysis. (A) Overall analysis; (B) The subgroup analyses of ethnicity; (C) study design; (D) sample size.

Figure 8

Forest plots of association between prostatitis and BPH.