Murtola Teemu J, Gurel Bora, Umbehr Martin, Lucia M Scott, Thompson Ian M, Goodman Phyllis J, Kristal Alan R, Parnes Howard L, Lippman Scott M, Sutcliffe Siobhan, Peskoe Sarah B, Barber John R, Drake Charles G, Nelson William G, De Marzo Angelo M, Platz Elizabeth A
Department of Urology, School of Medicine and Tampere University Hospital, University of Tampere, Tampere, Finland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Cancer Epidemiol Biomarkers Prev. 2016 Mar;25(3):463-9. doi: 10.1158/1055-9965.EPI-15-0987. Epub 2015 Dec 29.
A previous analysis of the placebo arm of the Prostate Cancer Prevention Trial (PCPT) reported 82% overall prevalence of intraprostatic inflammation and identified a link between inflammation and higher-grade prostate cancer and serum PSA. Here, we studied these associations in the PCPT finasteride arm.
Prostate cancer cases (N = 197) detected either on a clinically indicated biopsy or on protocol-directed end-of-study biopsy, and frequency-matched controls (N = 248) with no cancer on an end-of-study biopsy were sampled from the finasteride arm. Inflammation in benign prostate tissue was visually assessed using digital images of hematoxylin and eosin-stained sections. Logistic regression was used for statistical analysis.
In the finasteride arm, 91.6% of prostate cancer cases and 92.4% of controls had at least one biopsy core with inflammation in benign areas (P < 0.001 for difference compared with placebo arm). Overall, the odds of prostate cancer did not differ by prevalence [OR, 0.90; 95% confidence interval (CI), 0.44-1.84] or extent (P trend = 0.68) of inflammation. Inflammation was not associated with higher-grade disease (prevalence: OR, 1.07; 95% CI, 0.43-2.69). Furthermore, mean PSA concentration did not differ by the prevalence or extent of inflammation in either cases or controls.
The prevalence of intraprostatic inflammation was higher in the finasteride than placebo arm of the PCPT, with no association with higher-grade prostate cancer.
Finasteride may attenuate the association between inflammation and higher-grade prostate cancer. Moreover, the missing link between intraprostatic inflammation and PSA suggests that finasteride may reduce inflammation-associated PSA elevation.
先前对前列腺癌预防试验（PCPT）安慰剂组的分析报告显示，前列腺内炎症的总体患病率为82%，并确定了炎症与高级别前列腺癌及血清前列腺特异性抗原（PSA）之间的联系。在此，我们在PCPT非那雄胺组中研究了这些关联。
从非那雄胺组中选取在临床指征活检或方案指导的研究结束时活检中检测到的前列腺癌病例（N = 197），以及在研究结束时活检未发现癌症的频率匹配对照（N = 248）。使用苏木精和伊红染色切片的数字图像对良性前列腺组织中的炎症进行视觉评估。采用逻辑回归进行统计分析。
在非那雄胺组中，91.6%的前列腺癌病例和92.4%的对照至少有一个活检核心在良性区域存在炎症（与安慰剂组相比差异P < 0.001）。总体而言，前列腺癌的发病几率在炎症患病率[比值比（OR），0.90；95%置信区间（CI），0.44 - 1.84]或炎症程度方面无差异（P趋势 = 0.68）。炎症与高级别疾病无关（患病率：OR，1.07；95% CI，0.43 - 2.69）。此外，无论是病例组还是对照组，平均PSA浓度在炎症患病率或程度方面均无差异。
PCPT中，非那雄胺组前列腺内炎症的患病率高于安慰剂组，且与高级别前列腺癌无关。
非那雄胺可能减弱炎症与高级别前列腺癌之间的关联。此外，前列腺内炎症与PSA之间缺失的联系表明非那雄胺可能降低炎症相关的PSA升高。
