Inflammatory Bowel Disease Linked to Prostate Cancer

About one million men have inflammatory bowel disease in the USA, a common chronic condition that includes Crohn's disease and ulcerative colitis. Epidemiologic studies have noted an association between chronic inflammation and prostate cancer.

Prostate cancer is cancer that occurs in the prostate, a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

A team of urologists and physicians working with the Northwestern University (Evanston, IL, USA) investigated 1,033 men with inflammatory bowel disease (IBD) and a control group of 9,306 men without the disease. They followed the two groups of men for 18 years and found those with IBD were much more likely to have prostate cancer and higher prostate specific antigen (PSA) levels. Follow-up time for all patients was the duration between a patient's first PSA test and last physician encounter. The median age of both case and control groups at first PSA measurement was 53 years, and 74% were white.

The scientists reported that the 5- and 10-year incidences of any prostate cancer (PCa) were 2.8% and 4.4% for cases and 0.25% and 0.65% for controls, respectively. The crude incidences of any PCa were 715 cases in patients with IBD and 167 cases among controls per 100 000 person-years. The incidences of clinically significant PCa were 462 cases in patients with IBD and 115 cases among controls per 100,000 person-years. A total of 27, 221 PSA measurements were assessed for men without IBD and 3,357 for men with IBD. There was a slight trend toward a higher number of PSA tests and higher PSA values among patients with IBD. While PSA estimates were similar in younger patients, age-specific PSA values were significantly higher in patients with IBD in older age, starting at approximately age 60.

The authors concluded that in a retrospective matched-cohort study, men with IBD who underwent PSA-based PCa screening had higher rates of any and clinically significant PCa when compared with age- and race-matched men without IBD. These findings warrant future prospective investigation to better understand the relationship between IBD and PCa.

Shilajit D. Kundu, MD, an associate professor of urology and senior author of the study, said, “These patients may need to be screened more carefully than a man without inflammatory bowel disease. If a man with inflammatory bowel disease has an elevated PSA, it may be an indicator of prostate cancer. Many doctors think when the PSA is elevated, it is just because they have an inflammatory condition. There is no data to guide how we should treat these men.” The study was published on December 4, 2018, in the journal European Urology.

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