Inflammation and chronic prostatic diseases: Evidence for a link?

Objectives: Emerging evidence indicates that prostatic inflammation may contribute to prostate growth either in terms of hyperplastic (benign prostatic hyperplasia [BPH]) or neoplastic (prostate cancer [PCa]) changes. We propose two questions: Does prostate inflammation represent a significant factor for the development and the progression of both BPH and PCa? Are data available now to sustain the identification of prostate inflammation as a risk factor for prostate diseases? Methods: We reviewed the recent international literature using a PubMed search to analyze new findings supporting a role for inflammation in BPH and PCa growth and progression. Results: On histologic examinations from patients with BPH, inflammatory aspects are present in approximately 40% of cases. The men with inflammatory aspects inside the prostate have a significantly higher risk for BPH progression and acute urinary retention. Evidence shows that a cyclooxygenase-2 (COX-2) inhibitor can increase the apoptotic activity in human BPH tissue. Analyses on the, bacterial colonization in PCa and normal prostate tissue showed a highly suggestive correlation between bacterial colonization/chronic inflammation and the diagnosis of PCa. Evidence from genetic studies supports the hypothesis that prostate inflammation may be a cause of PCa development. Proliferative inflammatory atrophy has been considered as an early histologic precursor to prostatic intraepithelial neoplasia and PCa. Conclusion: The concept that inflammation can promote chronic prostatic diseases, such as BPH or PCa, is actually supported by several new significant findings; however, no specific oncologic surveillance for these cases is justified at the moment.