Originally published 8/4/2022
The blog below addresses inflammation of the prostate as a precursor for developing prostate cancer (PCa).
A presentation from the April 2024 European Association of Urology tackles the likelihood that the presence of prostate inflammation at the time of prostatectomy predicts the likelihood that PCa will recur within 5 years of treatment, as shown by rising PSA.
All 595 patients in a study were diagnosed by biopsy; the biopsy not only provided the Gleason grade group but also tissue samples that could be analyzed for the presence of inflammation. Inflammation scores from 1-3 were assigned based on the amount and type of inflammation seen in prostate samples, with 3 indicating the most inflammation, with “prostate cancer of any grade and interstitial infiltration of inflammatory cells with glandular disruption.”[i] The patients were followed for 5 years after surgery.
The authors found that after adjusting for age, Gleason score, clinical stage and PSA at diagnosis, The biochemical recurrence-free survival rates (no rising PSA) were 80% lower for patients with an inflammation score of 3. The authors suggest that analyzing biopsy cells for inflammation may be a way to anticipate which prostatectomy patients are more likely to experience a rising PSA within 5 years of treatment. This gives all the more reason to detect inflammation even before biopsy by using MRI, as described in the original blog below.
When you bump your forehead, you get a small area that’s noticeably red, warm, raised and tender. These are four classic marks (redness, heat, swelling, and pain) of inflammation. Inflammation can be visible, like the goose egg on your forehead, or invisible, like accumulating injury to lung tissues from smoking. Another sign of inflammation is loss of function, as in a sprained ankle.
Inflammation is a normal response to injury, disease, invasion by bacteria or viruses, exposure to toxins, and radiation. In the immediate moment, it is called acute inflammation. The body quickly acts: blood vessels dilate, and white blood cells—a component of the immune system—rush to the affected area. These cells release biochemicals into the blood stream to trigger other processes. Thus, acute inflammation is rapid, temporary, and protective. It gradually disappears as healing proceeds. However, other types of inflammation are “silent” and can linger indefinitely. This is called chronic inflammation. It is neither rapid, temporary, or protective. In fact, it is just the opposite: it can trigger cancerous mutations in many organ cells, including the prostate gland.
Inflammation is linked to two processes necessary for cancer development:
- Cell mutations that lead to tumor formation – Multiple factors can spark mutations in cells’ DNA, and chronic inflammation is one of them. Although the exact agents and the role they play are still being investigated, activated inflammatory cells can damage healthy cells’ DNA and set up genomic instability.[ii]
- Fostering tumor growth – When early tumors begin to outgrow their supply lines, they send out biochemical “lures” to attract another immune system component, a type of cell called a macrophage. In an acute inflammation, macrophages are present but in relatively small numbers. However, macrophages live longer than some other types of cells, so in an ongoing chronic inflammation their numbers multiply. When tumor cells attract macrophages, they “hijack” the cytokines (chemicals that signal cells to behave in certain ways) that macrophages secrete, helping build new tumor blood vessels (angiogenesis). “Meanwhile, other inflammatory cells spritz the tumour with molecules (free radicals) that further damage their DNA. Inflammation might also fire the starting gun for metastasis by producing chemicals that help tumour cells nibble through the molecules tethering them to their surroundings.”[iii]
Thus, the relationship between inflammation and prostate cancer (PCa) is a vicious circle. If an acute inflammation becomes chronic, there is a risk that it will cause cellular mutations, including cancerous cells. If these cells begin to grow as a tumor, the cancer cells can hijack macrophage signaling chemicals.
Inflammation of the prostate gland
Inflammation of the prostate is called prostatitis. Acute prostatitis is a serious bacterial infection that should be diagnosed as soon as possible and treated with antibiotics. Chronic prostatitis, on the other hand, may have a bacterial cause, or no cause that can be found. If there is no known cause, trying to treat is often becomes a haphazard process of elimination. Meanwhile, symptoms persist, often leading to a condition called chronic pelvic pain syndrome (CPPS). Antibiotics and pain-killers may be ineffective.
A third type of prostatitis is called asymptomatic prostatitis, meaning there are no specific symptoms to suggest inflammation. However, benign prostatic hyperplasia (BPH, a gland enlargement that often happens with aging) is frequently associated with asymptomatic prostatitis. Since most men with BPH do not seek physician intervention unless they have urinary symptoms (frequency, difficulty urinating, slow stream etc.), they may harbor inflammation for years without knowing it.
Identifying inflammation: mpMRI
There is no way to screen for chronic prostate inflammation, but the Sperling Diagnostic Center provides expert detection and diagnosis of prostate disease thanks to our state-of-the-art 3 Tesla multiparametric MRI (3T mpMRI) of the prostate. Dr. Dan Sperling is a leading authority in the differentiation of prostate conditions that appear similar to a less experienced reader. These conditions include inflammation/prostatitis, BPH, PCa, or precancerous conditions like high grade PIN and ASAP.
If an area is revealed that is suspicious for prostate cancer, Dr. Sperling can immediately do an in-bore MRI guided targeted biopsy to sample suspicious areas with a minimal number of needles for the most accurate diagnosis.
Identifying inflammation and diagnosing the source can act as a pre-emptive strike against prostate cancer. A growing body of literature supports the merits of 3T mpMRI. If you are concerned about BPH, prostatitis, or chronic pelvic pain syndrome, contact the Sperling Prostate Center.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Guzzi F, Falagario UG, Fanelli A, et al. Peritumoral inflammation in prostate biopsy core predict biochemical recurrence after active treatment for prostate cancer. Presented at: EAU24, Paris, France, April 5-8. Poster A0298.
[ii] Grivennikov S, Greten F, Karin M. Immunity, inflammation, and cancer. Cell. 2010 Mar 19;140(6):883-99.
[iii] Danovi, Safia. “Feeling the heat—the link between inflammation and cancer.” Cancer Research UK, Feb. 1, 2013. http://scienceblog.cancerresearchuk.org/2013/02/01/feeling-the-heat-the-link-between-inflammation-and cancer/
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
