Abstract
Prostate cancer (PC) risk differs between races, and we previously showed prostate inflammation in benign prostate tissue was linked with a lower future PC risk. However, whether prostate tissue inflammation varies by race is unknown. We analyzed baseline acute and chronic prostate inflammation by race in REDUCE, a 4-year, multicenter, placebo-controlled study where all men had a negative prostate biopsy prior to enrollment. We included 7,982 men with standardized central pathology review to determine the presence or absence of chronic or acute inflammation in baseline prostate biopsy tissue. Logistic regression was used to compare prostate inflammation by race, adjusting for confounders. Of 7,982 men, 7,271 were white (91.1%), 180 (2.3%) black, 131 (1.6%) Asian, 319 (4.0%) Hispanic and 81 (1%) unknown. A total of 78% had chronic and 15% had acute inflammation. On multivariable analysis relative to white men, black men were less likely (OR = 0.65, 95%CI: 0.41-1.03, p = 0.07) and Asian men more likely to have acute inflammation (OR = 1.74, 95%CI: 1.14-2.65, p = 0.001). Hispanic men had similar levels of acute inflammation as white men. Chronic inflammation did not significantly differ across races. We identified racial differences in acute inflammation, particularly in Asian men, in benign prostate tissue that inversely mirrored population-level data on PC race disparity. As we showed in REDUCE that acute inflammation is linked with lower future PC risk, if validated in future studies, these data suggest racial differences in prostatic acute inflammation may contribute in part to race differences in PC risk, especially among Asian men.
Highlights
While it has been postulated inflammation drives prostate cancer (PC) development [1], the link between inflammation and PC risk appears to be complex
Race was significantly associated with geographic region (p < 0.001), abnormal digital rectal examination (DRE) (p < 0.001), prostate-specific antigen (PSA) (p = 0.018), prostate volume (p < 0.001), and aspirin and/ or NSAID use (p < 0.001) (Table 1)
Race was significantly associated with the presence of acute inflammation (p = 0.015), but not with the presence of chronic inflammation (p = 0.112) in the pre-study negative biopsy (Table 1)
Summary
While it has been postulated inflammation drives prostate cancer (PC) development [1], the link between inflammation and PC risk appears to be complex. REDUCE was a multinational randomized clinical trial designed to compare the effect of dutasteride on PC diagnosis among men with a negative prestudy biopsy and elevated PSA [6] This biopsy was centrally reviewed by a single pathologist who graded it systematically for inflammation. Similar results were found in a Finnish study of 293 men with a negative biopsy, with histological inflammation associated with decreased PC risk at follow-up [3]. These studies suggest acute inflammation in a benign biopsy may portend a lower future PC risk. Whether these disparate results reflect differences in acute vs. chronic inflammation or differences in examining benign prostate tissue predicting future PC risk vs. looking at PC tissue is not clear
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