Analysis of the prevalence of inflammation and benign prostatic hyperplasia in Asian and Caucasian men at autopsy, "Beyond the Abstract," by Alexandre R. Zlotta

BERKELEY, CA (UroToday.com) - The pathogenesis of cancer represents an extremely complex and multifactorial process involving a number of acquired and genetic defects, with genetic, epigenetic, transcriptomic, and post-transcriptional changes. It is becoming increasingly apparent that many cancers originate from a chronic inflammatory process such as gastrointestinal cancers for instance. Wound healing and cancer share striking similarities, including the growth of new blood vessels, fibrosis and cell-to-cell adhesion features. Tumors have been labelled as wounds that don’t heal.

In urology, inflammation has also been suggested to be involved in the pathogenesis of prostate disorders such as prostate cancer and benign prostatic hyperplasia (BPH). It has indeed been hypothesized that various different stimuli may induce chronic prostatic inflammation, which in turn would lead to tissue damage and continuous wound healing, thus contributing to prostatic enlargement. BPH is the most frequent benign neoplasm in aging males and one of the most common chronic conditions in the male population, with a histological prevalence at autopsy of 50% in men aged 50–60 years and of 90% over 80 years old. The majority of men with BPH have inflammatory cells infiltrating BPH tissues. Chronic histologic inflammation was found in more than 78% of men in the REDUCE trial, a large scale, 8000-men, 4-year clinical trial designed to determine if and to what extent the dual 5α reductase inhibitor dutasteride reduced the risk of biopsy-detectable prostate cancer compared with placebo in men at higher risk of being diagnosed with prostate cancer. Most studies analyzing prostatic inflammation had been carried out in specific populations though, either known BPH patients, elevated PSA, etc. but extremely rarely on autopsies and even more rarely comparing Asian and Caucasian populations with dramatically different lifestyles.

We therefore studied the prevalence of inflammation and BPH in Asian and Caucasian men on prostate glands (n320) obtained during autopsy in Moscow, Russia (Caucasian men,= n220), and Tokyo, Japan (Asian men,= n100). These men who died from other causes than prostate cancer and the populations had very low rates of PSA screening. We used the same methodology to harvest prostates in Japan and Russia and had a central pathology review. We correlated the presence and grade of acute inflammation (AI) or chronic inflammation (CI) and BPH. AI, CI, and histologic BPH were analyzed in a blinded fashion using a grading system (0–3) by an expert uro-pathologist, Professor Theo Van der Kwast. We observed that histologic BPH was seen in a similar high proportion of Asian and Caucasian men (> 70%). We also observed that the higher the degree of BPH, the higher the chronic inflammation. In multivariate analyses, independently from all other parameters, individuals with CI were 6.8 times more likely to have a higher BPH score than individuals without, a very significant difference (p < 0.0001). A limitation of our study was that men included in this study presented at the hospital, and their symptomatic status was not known, but we avoided on the other hand, selecting patients based on their symptomatic status or PSA levels.

We conclude that the prevalence of chronic inflammation and BPH on autopsy is similar (and very high, > 70%) in Asian and Caucasian men, despite very different diet and lifestyle. Chronic inflammation is strongly associated with BPH in both groups. 

Written by:
Alexandre R. Zlotta as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

Prevalence of inflammation and benign prostatic hyperplasia on autopsy in Asian and Caucasian men - Abstract

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