Premium
Histological inflammation and risk of subsequent prostate cancer among men with initially elevated serum prostate‐specific antigen ( PSA ) concentration in the F innish prostate cancer screening trial
Author(s) -
YliHemminki Tytti H.,
Laurila Marita,
Auvinen Anssi,
Määttänen Liisa,
Huhtala Heini,
Tammela Teuvo L.J.,
Kujala Paula M.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12153
Subject(s) - medicine , prostate cancer , hazard ratio , biopsy , prostate biopsy , prostate specific antigen , rectal examination , prostate , cancer , urology , confidence interval , population , proportional hazards model , malignancy , gastroenterology , gynecology , oncology , environmental health
Objective To assess whether histological signs of inflammation are associated with an increased risk of subsequent prostate cancer ( PCa ) in men with elevated serum prostate‐specific antigen ( PSA ) concentrations and benign initial biopsy.Materials and Methods Study subjects were men aged 54–67 years with an elevated PSA (≥4 ng/mL or 3–4 ng/mL and free to total PSA ratio ≤0.16 or positive digital rectal examination), but a benign biopsy result within the F innish population‐based randomised screening trial for PCa , which started in 1996. A total of 293 prostate biopsies without PCa or suspicion of malignancy from the first screening round in the T ampere centre were re‐evaluated by a uropathologist to assess histological inflammation. Results of the subsequent screening rounds were obtained from the trial database and PCa diagnoses made outside the screening were obtained from the F innish C ancer R egistry. The median length of follow‐up was 10.5 years. Cox regression analysis was used to assess PCa risk after the initial benign biopsy.Results Histological inflammation was found in 66% of the biopsies. Subjects with inflammation at the biopsy had a slightly lower PCa risk in the second screening round (18 vs 27%, rate ratio 0.69, 95% confidence interval [ CI ] 0.35–1.34) relative to men without inflammation. In further follow‐up, the PCa risk remained nonsignificantly lower (hazard ratio [ HR ] 0.71, CI 0.46–1.10; P = 0.13). The risk was not appreciably affected by adjustment for age, PSA , prostate volume and family history of PCa ( HR 0.67, CI 0.42–1.07; P = 0.092).Conclusions Histological inflammation in a prostate biopsy among men with an initial false‐positive screening test was not associated with an increased risk of subsequent PCa , but instead with a decreased risk which was of borderline significance. Inflammation in prostate biopsy is not a useful risk indicator in PCa screening.