SAN ANTONIO – One man in seven will develop prostate cancer in his lifetime ─ it's the second leading cause of cancer deaths in men, behind lung cancer. New research shows some men may have twice the risk of developing prostate cancer if they've shown signs of chronic inflammation in their prostate. It's knowledge that eventually could be used in early detection.
Since 2001, 68-year-old Ira Abbott has been doing his part to advance medical science. Ira volunteered to be part of a research study, focusing on prostate cancer.
Twelve years after Ira enrolled in the study, he received some unsettling news.
"I had gotten a personal note form the doctor saying hey, you need to come in and talk to us about this," Ira Abbott told Ivanhoe.
Results from his prostate specific antigen or PSA test raised a flag.
"It indicated that well, it was a 10.5, and that's pretty high," Abbott explained.
A biopsy revealed he had prostate cancer. Ira's case and others like his have allowed researchers to study chronic inflammation in the prostate and its relation to prostate cancer.
"We've always seen in the biopsies of many patients with prostate cancer or some without ─ we see the inflammatory cells in the prostate," Ian Thompson, M.D., Director of Cancer Therapy & Research Center at the University of Texas Health Science Center, San Antonio, told Ivanhoe.
Dr. Thompson is one of several of the study's researchers who believes the two might be related. They now want to know what causes the inflammation, how it may contribute to cancer ─ and if the inflammation can be prevented.
Ira chose to move forward by having his prostate removed. He's now doing the things he loves and is thankful to be back on the road to recovery.
"I'm glad it was taken care of early," said Abbott.
Researchers caution that this study does not prove that inflammation causes cancer. Dr. Thompson says the findings could eventually be used as an augmented tool for the PSA test.
BACKGROUND: In 2014, in the U.S., there have been approximately 233,000 cases of prostate cancer. There are four stages of prostate cancer, ranging from early-stages to advanced cancer. The stage can depend on several factors, such as cancer cells invading surrounding tissue, spreading to lymph nodes, the Gleason score or grade of the tumor and the Prostate Specific Antigen (PSA) level. PSA is made by the prostate gland and found in the blood. It has not been determined what a normal range PSA level is, but in the past, doctors have used levels of PSA 4.0ng/ml and lower as normal. This number, however, does not automatically indicate that cancer is present; studies have shown that some patients with high PSA levels do not have cancer, while those with lower levels do have cancer.
PROSTATITIS: Prostatitis, or inflammation of the prostate gland, accounts for approximately two million visits to urology practices per year. There are four main classifications of prostatitis: acute bacterial prostatitis (least common) is caused by a sudden bacterial infection that includes flu-like symptoms. Chronic bacterial prostatitis is characterized by recurring bacterial infections to the prostate; between attacks a patient may be symptom free. Chronic prostatitis/chronic pelvic pain syndrome is the most common category however the least understood. Depending upon the presence or absence of infection-fighting cells in bodily fluids, it can be categorized as inflammatory or non-inflammatory, with symptoms that can come and go. Finally, asymptomatic inflammatory prostatitis is often found by accident during an infertility or prostate exam if infection-fighting cells are found in bodily fluid.
NEW DISCOVERY: Dr. Ian Thompson, M.D., Director of the Cancer Therapy & Research Center at the University of Texas Health Science Center, at San Antonio told Ivanhoe that he believes there is a connection between prostatitis and a prostate cancer diagnosis. In his study with colleagues, it was discovered that chronic inflammation was common in benign in prostate tissue and was positively associated with high-grade prostate cancer. The impact and result of this study suggests that by preventing inflammation could reduce the risk of a prostate cancer diagnosis.
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Ian Thompson, M.D., Director of the Cancer Therapy and Research Center at the University of Texas Health Science Center, San Antonio, talks about the correlation between chronic inflammation of the prostate and prostate cancer.
Interview conducted by Ivanhoe Broadcast News in September 2014.
Dr. Thompson, explain this to me, chronic inflammation and its relation to prostate cancer; how are you able to relate the two?
Dr. Thompson: Well we've known for many years that inflammation, inflammatory cells, is present in the prostate. And we know in many other cancers that inflammation seems to be somehow causally associated with cancer development. We've always seen in the biopsies of many patients with prostate cancer, and in some patients without cancer, inflammatory cells in the prostate. The question was is the inflammation just an ‘innocent bystander' or is it somehow related to the development of cancer. One of the thoughts was perhaps it was a bacterium or a virus and that an infection itself was related to the development of cancer. We still don't know if that's the case. But we don't have clear evidence that it's one or the other. In the study that we just completed we examined tissues from a study that we did earlier on. We asked the question: if you saw inflammation in one part of the prostate and if you gave it a grade of ‘one, two or three', what was the chance that there was cancer elsewhere in the prostate. We found that this inflammation was highly associated with cancer, elsewhere in the prostate. But even more importantly because there's a broad range of types of prostate cancers, from the very, very slow growing to the very fast-growing, an important observation was that inflammation was very significantly associated with the presence of the presence of a fast-growing cancer elsewhere in the prostate. That's the fascinating thing about this study. Of course the question is what do you do with that information; what's the next step? The first part of that is that we need to continue our search to find out why the inflammation is there in the first place.
Does everybody have inflammation?
Dr. Thompson: Not everybody has inflammation; some people have none and some people have an only small amount of inflammation. Sometimes the inflammation is in the scaffolding of the prostate and sometimes it's in the glands the tubules of the prostate. These patterns of inflammation are very different and are of a varying degree. Some people have significant amounts of inflammation. So we need to continue our quest to find out if there's something that is causing the inflammation and then the inflammation just like the inflammation in sunburn that then leads to a cancer whether that inflammation results in the cancer. It's a very important question that needs be answered. The next important question is whether you can you somehow use this information to help patients. Let's take a common example: A man today goes in and sees his doctor; his PSA is high and a prostate biopsy is done and it finds no cancer. Nonetheless, his PSA is still high. Nowadays we do additional blood tests, urine tests, and MRIs. In some men, I find that they've had five or six biopsies in the quest to ensure that a cancer wasn't missed. The question is whether you could use, in the first biopsy, how much inflammation was present to determine if you should re-biopsy the patient. If the inflammation level is absent or low, perhaps only follow-up would be needed.
Somebody who is in that age frame where they need to be more vigilant, are there any signs of the chronic inflammation?
Dr. Thompson: That's a very good question. Are there signs for chronic inflammation – the answer: generally not. Most people don't have any symptoms at all. But there are of course then there's always the exception. Some men have chronic inflammation in the prostate and do have symptoms. At this point in time we don't know whether their risk is higher or not. But in general, urinary symptoms and prostate cancer are completely unassociated. This is why, if you think it's important to reduce a man's risk of dying from prostate cancer you can't use symptoms as an early detection method for prostate cancer. You have to use other early detection testing such as PSA testing.
So what's your advice to people out there that are in that age range?
Dr. Thompson: If they are seeking an early detection test for prostate cancer, the very best at this time remains the PSA test. The decision to have a PSA test should be a discussion between the patient and his physician; it should be an informed decision. The one thing we don't advise is walking into a health fair and having your PSA drawn without fully understanding what's involved. This is because, for example, in the case of a very young man who has very low risk factor, his likelihood of benefiting from a PSA test is extremely low. Risk factors that may change that decision would include as he gets older, say after the age of about 55, 50 or 55, if he were an African-American man, a man with a family history of prostate cancer, or simply a man who's concerned about his risk of prostate cancer. Men considering PSA testing should have a discussion with their physician because there are advantages and disadvantages. It takes a little bit of time and it's actually similar to the process you do when you're going to buy a new television set. You go to Consumer Reports, look it up, look at the pros and cons, and do your homework. The same thing is essential before a man has a PSA test. He should do his homework and then think about his own priorities, his own risk factors, and then make a decision that's right for him. Not everybody is going to come to the same conclusion. One thing that I think is correct is that not everyone will choose the same path as people have different expectations and different risks.
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.