Abstract
BackgroundSexually transmitted infections (STIs) are hypothesized to play a role in the development of prostate cancer, perhaps due to inflammation-induced oncogenesis. We assessed in a nationally representative population of middle-aged men whether sexual behavior indicators for an increased risk of genital infection were associated with serum prostate-specific antigen (PSA) concentration, a marker of prostatic disease and inflammation.ResultsThe percentage of men between the ages of 40 and 59 with a PSA ≥ 4.0 ng/ml was 2.6% (95% confidence interval [CI], 1.8% – 3.8%). The percentage of men between the ages of 40 and 59 self-reporting a past diagnosis of genital warts or genital herpes, or a recent diagnosis of gonorrhea or chlamydia is estimated to be 7.3% (95% CI, 6.2% – 8.6%). Men self-reporting that they had had sex without using a condom in the past month had a lower PSA concentration and higher %fPSA than those who did not. There were no associations between any of the other sexual activity or laboratory measures and PSA or %fPSA.ConclusionIn this nationally representative sample of middle-aged American men, we did not find consistent evidence for an association between sexual behavior or a history of STIs and PSA levels. Therefore, sexual factors are unlikely to lead to falsely elevated PSA tests in this population. We cannot rule out the role of these factors in causing false positive PSA tests in subgroups of the population that have a higher prevalence of high-risk sexual behavior, and more protracted or recent exposures to these agents.
Highlights
Transmitted infections (STIs) are hypothesized to play a role in the development of prostate cancer, perhaps due to inflammation-induced oncogenesis
[14] Of the 1513 interviewed men 40 to 59 years of age, 1456 (96.2%) participated in the physical examination. Of these 1456 men, 29 (2.0%) did not provide consent for prostate-specific antigen (PSA) testing, refused to answer the consent question, or responded "don't know," 36 (2.5%) were considered ineligible because of other National Health and Nutrition Examination Survey (NHANES) PSA exclusion criteria, an additional 65 (4.5%) men were missing information on either the consent question or at least 1 of the exclusion criteria, and 33 (2.3%) were eligible but had a missing PSA result, leaving a final study population of 1293 men (1293/1456, or 88.8% of all men between 40 and 59 years of age who participated in the physical examination)
Race/ethnicity was not associated with PSA levels in this sub-section of the NHANES population
Summary
Transmitted infections (STIs) are hypothesized to play a role in the development of prostate cancer, perhaps due to inflammation-induced oncogenesis. We assessed in a nationally representative population of middle-aged men whether sexual behavior indicators for an increased risk of genital infection were associated with serum prostate-specific antigen (PSA) concentration, a marker of prostatic disease and inflammation. PSA levels are known to increase during episodes of symptomatic bacterial prostatitis,[8] and they have been shown to vary by the histological extent of asymptomatic inflammation[9,10] One cross-sectional study of men at an STI clinic found an inverse association between age at first intercourse and mean PSA, as well as a positive association between higher titers of antibodies to Chlamydia trachomatis and PSA values. We examined the association of serological evidence of infection with T. pallidum (syphilis) or herpes simplex virus-2 (HSV-2) with serum PSA values These STIs are themselves markers of high-risk sexual behavior, [13] but have not been shown to directly infect the prostate or to induce prostatic inflammation
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