Inflammatory bowel disease and risk of prostate cancer: A matched-cohort analysis.

Abstract

55 Background: There are few data on the risk of prostate cancer (PCa) in men with inflammatory bowel disease (IBD) and there are no data comparing serum prostate-specific antigen (PSA) values between men with IBD and matched men without IBD. Methods: This study retrospectively matched men with IBD based on race and age 1 to 9 to men without IBD (controls) who underwent PCa screening with at least one PSA at a single academic medical center from 1996 to 2017. Kaplan-Meier and multivariable Cox analyses were used to compare the risk of any and clinically significant PCa (Gleason grade group > 1) between the two groups adjusting for number of PSA tests, abnormal rectal exam, age, and race. A mix-effects regression was used to assess the association between PSA and IBD status. Results: After a median follow-up of 6.5 years for 1,033 men with IBD and 4.7 years for 9,306 controls, the median number of PSA tests was 2, 74% were white, and median age at first PSA (starting point of follow-up) was 53 years. At 10 years of follow-up, the incidence of any PCa was 0.65% for controls and 4.4% for men with IBD (HR 4.37, 95% CI 3.08-6.19, p < 0.001) and of clinically significant PCa was 0.42% for controls and 2.4% for men with IBD (HR 3.78, 95% CI 2.40-5.96, p < 0.001). When only men with IBD were assessed, use of biologic medications, duration of IBD diagnosis, history of bowel resection, Crohn’s disease versus ulcerative colitis were not associated with PCa diagnoses (all p > 0.1). Any steroid treatment for IBD was associated with decreased incidence of any PCa (HR 0.22, 95% CI 0.06-0.78, p = 0.019), but not with clinically significant PCa (p = 0.5). PSA values were higher among men with IBD starting at age 60 (1.12 ng/mL vs 1.04 ng/mL, p = 0.031) and this gap widened with increasing age (age 70: 1.54 ng/mL vs 1.32 ng/mL, p = 0.007). Conclusions: Men with IBD being screened for PCa had an increased incidence of all and clinically significant PCa compared to age- and race-matched controls and had increased PSA values at older age. These findings should be further validated to consider IBD as a risk factor for PCa and optimize screening for this population.