Sexually transmitted infections and prostatitis in the etiology of prostate cancer and benign prostatic hyperplasia

Background. Although previous case-control studies have observed positive associations for sexually transmitted infections (STI) and clinical prostatitis in relation to prostate cancer and benign prostatic hyperplasia (BPH), the majority of these studies were limited by small sample size, and retrospective and self-reported assessment of a narrow range of exposures (typically gonorrhea, syphilis and clinical prostatitis). To further explore associations between STIs, clinical prostatitis and later prostate disease, and to address some of the limitations of previous studies, we conducted three prospective investigations of STIs, including gonorrhea, syphilis, Trichomonas vaginalis and human papillomavirus (HPV) infection, and clinical prostatitis as they relate to subsequent development of prostate cancer and BPH, followed by a prospective investigation of STI-mediated intraprostatic inflammation in the current antibiotic era.; Methods. The first three studies were conducted within the Health Professionals Follow-up Study (HPFS), a large prospective study of middle- to older-aged male health professionals (n = 51,529). In 1992, HPFS participants were asked to report their histories of gonorrhea, syphilis, clinical prostatitis, prostate cancer and BPH by mailed questionnaire. Information on prostate cancer and BPH was updated on each subsequent biennial follow-up questionnaire. Histories of T. vaginalis and HPV infection were assessed by serologic antibody detection among prostate cancer cases (n = 691) and matched controls (n = 691). The fourth study was conducted among Baltimore City STI clinic patients. STI-mediated intraprostatic inflammation was assessed by measuring prostate specific antigen (PSA) concentration in archived serum specimens from visits before, during and after exudative STI diagnoses.; Results. With respect to prostate cancer, a borderline significant positive association was observed for T. vaginalis seropositivity, but not for HPV seropositivity or self-reported histories of gonorrhea, syphilis or clinical prostatitis. For BPH, significant positive associations were observed for both self-reported histories of gonorrhea and young-onset prostatitis. In the final study, a rise in PSA concentration was observed among a subset of men with acute, exudative STIs.; Conclusions. These findings suggest that certain STIs and genitourinary infections may be associated with the development of prostate cancer and BPH, consistent with the emerging view of inflammation in the etiology of prostate disease.