Objective
To evaluate whether baseline prostate atrophy (PA) extent is associated with prostate
cancer (PCa) incidence at 2-year repeat prostate biopsy in a clinical trial with systematic
biopsies.
Materials and Methods
We performed a retrospective analysis of 3165 men 50-75 years old with prostate-specific
antigen between 2.5 and 10 ng/mL and a prior negative biopsy in the placebo arm of
the Reduction by Dutasteride of PCa Events trial who underwent a 2-year repeat biopsy.
PA extent was defined as the percentage of cores with atrophic changes. The association
of baseline PA with positive 2-year biopsies was evaluated with logistic regression
in uni- and multivariable analysis, controlling for baseline covariates.
Results
PA involving none, 1%-25%, 26%-50%, 51%-75%, and >75% of the baseline cores was observed
in 966 of 3165 (30.5%), 1189 of 3165 (37.6%), 677 of 3165 (21.4%), 209 of 3165(6.6%),
and 124 of 3165 (3.9%) cases, respectively. More extensive PA was associated with
older age, lower prostate-specific antigen, larger prostate volume, and higher prevalence
of acute and chronic inflammations (all P < .05). Compared to subjects without PA, those with 1%-25%, 26%-50%, 51%-75%, and
>75% core involvement had an odds ratio for PCa of 0.65 (95% confidence interval [CI] = 0.52-0.81),
0.60 (95% CI = 0.46-0.78), 0.56 (95% CI = 0.37-0.86), and 0.35 (95% CI = 0.19-0.67),
respectively. In multivariable analysis, the extent of PA was independently associated
with lower PCa risk (P < .001). More extensive PA was associated with lower incidence of low-grade (Gleason
2-6) and high-grade (Gleason 7-10) PCa.
Conclusion
The extent of baseline PA is independently associated with lower PCa risk in a dose-dependent
fashion.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Atrophy in prostate needle biopsy cores and its relationship to prostate cancer incidence in screened men.Urology. 2005; 65: 745-749
- Inflammation, focal atrophic lesions, and prostatic intraepithelial neoplasia with respect to risk of lethal prostate cancer.Cancer Epidemiol Biomarkers Prev. 2011; 20: 2280-2287
- Prostatic atrophy: an autopsy study of a histologic mimic of adenocarcinoma.Mod Pathol. 1998; 11: 47-54
- Focal prostatic atrophy: mimicry of prostatic cancer on TRUS and 3D-MRSI studies.Abdom Imaging. 2009; 34: 271-275
- Morphological transition of proliferative inflammatory atrophy to high-grade intraepithelial neoplasia and cancer in human prostate.Prostate. 2009; 69: 1378-1386
- Atrophy in specimens of radical prostatectomy: is there topographic relation to high-grade prostatic intraepithelial neoplasia or cancer?.Int Urol Nephrol. 2011; 43: 397-403
- Inflammatory atrophy on prostate needle biopsies: is there topographic relationship to cancer?.Int Braz J Urol. 2007; 33 (discussion 361-3): 355-360
- Clinical significance of proliferative inflammatory atrophy finding in prostatic biopsies.Prostate. 2015; 75: 1669-1675
- Baseline prostate atrophy is associated with reduced risk of prostate cancer in men undergoing repeat prostate biopsy.J Urol. 2015; 194: 1241-1246
- The environment and disease: association or causation?.Proc R Soc Med. 1965; 58: 295-300
- Effect of dutasteride on the risk of prostate cancer.New Engl J Med. 2010; 362: 1192-1202
- The dual 5-alpha-reductase inhibitor dutasteride induces atrophic changes and decreases relative cancer volume in human prostate.Urology. 2005; 65: 76-82
- Inflammation, atrophy, and prostate carcinogenesis.Urol Oncol. 2007; 25: 398-400
- Different types of atrophy in the prostate with and without adenocarcinoma.Eur Urol. 2007; 51: 98-103
- Inflammation, focal atrophic lesions, and prostatic intraepithelial neoplasia with respect to risk of lethal prostate cancer.Cancer Epidemiol Biomarkers Prev. 2011; 20: 2280-2287
- Serum testosterone and dihydrotestosterone and prostate cancer risk in the placebo arm of the reduction by dutasteride of prostate cancer events trial.Eur Urol. 2012; 62: 757-764
- BPH: a tell-tale sign of prostate cancer? Results from the prostate cancer and environment study (PROtEuS).World J Urol. 2015; 33: 2063-2069
- Extent of prostatic atrophy in needle biopsies and serum PSA levels: is there an association?.Urology. 2007; 69: 927-930
Article info
Publication history
Published online: December 23, 2016
Accepted:
December 16,
2016
Received:
November 22,
2016
Footnotes
ClinicalTrials.gov Identifier: NCT00056407.
Financial Disclosure: Gerald L. Andriole Jr is a member of the Consulting and Advisory Board at GlaxoSmithKline, PLC, and he has received speaker fees and research support from GlaxoSmithKline, PLC. Ramiro Castro-Santamaria is an employee at GlaxoSmithKline, PLC. Stephen J. Freedland received research support from GlaxoSmithKline, PLC. The remaining authors declare that they have no relevant financial interests.
Identification
Copyright
Published by Elsevier Inc.
