ASPO Abstracts
Clinical Prostatitis and Prostate Cancer: A meta-analysis evaluating the influence of detection bias
Category: Inflammation & Cancer, Pre-Malignant Conditions
Conference Year: 2018
Abstract Body:
Purpose: Previous meta-analyses have estimated a positive association between a history of clinical prostatitis and prostate cancer. However, these meta-analyses included a mixture of studies that did and did not take into account detection bias, i.e., the possibility for increased prostate cancer screening and detection in men with clinical prostatitis. Therefore, we performed an updated meta-analysis to summarize the evidence of this association, accounting for detection bias. Methods: Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform were searched for studies that investigated the possible relation between clinical prostatitis and prostate cancer through October 2017. Summary odds ratios (ORs) were calculated using random- effects meta-analysis. Results: 39 studies were eligible for analysis, including 34 case-control studies, 3 cohort studies, and 2 cross- sectional studies. An increased odds of prostate cancer was seen among men with a history of clinical prostatitis (OR=1.89, 95% CI 1.55-2.29) for all studies combined, although this estimate decreased slightly among studies (n=15) that performed any analysis to limit the influence of detection bias (OR=1.67, 95% CI 1.23-2.27), and decreased to a null value among studies (n=5) that performed the most rigorous analyses to limit detection bias (i.e., those that excluded men with prostatitis diagnoses close in time (~12 months) to their cancer diagnosis (OR=1.09, 95% CI 0.85-1.39)). Conclusion: Previously reported positive associations between clinical prostatitis and prostate cancer were likely mostly due to detection bias. A diagnosis of clinical prostatitis may comprise several conditions with a large proportion not involving inflammation (ie., chronic pelvic pain syndrome), efforts in this area focused on symptomatic and asymptomatic inflammation might be more useful in determining association with prostate cancer.
Keywords: prostatitis, inflammation, prostate cancer