November 1, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume II, Autum 2005

Could Fighting Chronic Prostate Inflammation Help Prevent Cancer?

Imagine going around with chronic sunburn on your face: Your muscles hurt from being tense all the time; it hurts to smile.Your pulse is higher, too, from the strain. Even though you are able to function, the discomfort is always there, wearing away at your body, making you vulnerable.

This is what it’s like, on a much smaller scale, for the prostate, which is prone to inflammation (even though this doesn’t always cause noticeable symptoms). Cells called inflammatory infiltrates are immune-system cells that migrate into inflamed tissue. Their job is to clean up infection, and generally make sure it doesn’t happen again.“These infiltrates may be there as a response to prostate infection, chemical or physical damage to the prostate’s epithelium (lining), and even changing hormone levels within the prostate,” explains Elizabeth Platz,Sc.D., M.P.H., associate professor of epidemiology, urology and oncology. Butsometimes, these cells can outstay their wel-come. “If the inflammatory response per-sists unnecessarily” — creating a situation ofchronic stress — “it may create an environ-ment that is conducive to cancer,” she adds.For the last few years, this possibility hasintrigued scientists, who are actively lookingto answer this question: “If we can inhibitchronic inflammation, can we reduce thefuture risk of prostate cancer?”

Scientists have a ready-made population inwhich to start looking — men taking aspirinor other nonsteroidal anti-inflammatorydrugs (NSAIDS). These drugs block chemi-cals called cyclo-oxygenase enzymes, whichplay a key role in the body’s inflammatoryresponse. One large study of these men foundthat men taking NSAIDS had a 15 percentlower risk of developing prostate cancer thanmen who weren’t taking them.

Platz, with colleagues at Hopkins and atthe National Institute of Aging, recentlystudied 1,244 men participating in the Balti-more Longitudinal Study of Aging, a studybegun more than 40 years ago and involvingabout 1,500 men, who return every otheryear for physical examinations and medicaltests — including an assessment of their useof prescription and over-the-counter drugs.The researchers found that men who usedaspirin or other NSAIDS had a 29 percentlower risk of prostate cancer than men whodid not use these drugs; this work was pub-lished in the journal Cancer Epidemiology, Biomarkers & Prevention.

One concern with this study, Platz says,was the possibility that inflammation dam-ages the epithelial cells, and causes PSA to

“If we can inhibit chronic inflam-mation,can we reduce thefuture risk of prostate cancer?”

leak out of the prostate and into the blood-stream. Did some of these men have falselylowered PSA scores because they were takingNSAIDS — in other words, did treatinginflammation actually mask a man’s truePSA level, and were some cancers not detected because the PSA wasn’t getting outof the prostate at levels high enough to beconsidered significant? To address this issue,Platz and colleagues studied 933 of the men who did not have prostate cancer and who,over the years, had undergone a combinedtotal of 3,749 PSA tests. In these men, therewas no difference between those who usedNSAIDS and those who didn’t. “Thus, thelower risk of prostate cancer in the users ofaspirin and non-aspirin suggests a modest,but possibly genuine benefit of these anti-inflammatory drugs.”

 

 

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