The role of inflammation and infection in the pathogenesis of prostate carcinoma

Authors


Florian M.E. Wagenlehner, Department of Urology, Justus-Liebig-University Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany. e-mail: wagenlehner@aol.com

Abstract

Two of the mini reviews are about aspects of prostate cancer that are currently often discussed. The role of inflammation in the pathogenesis of prostate cancer is of great interest and has led to many important changes in our approaches to the subject of prostate cancer. Intermittent androgen deprivation has been an alternative therapeutic option for some time, but the absence of a large multicentre randomized controlled trial has delayed its general acceptance; this is discussed in detail in this section.

Prostatitis and prostate carcinoma are both frequent entities of prostatic diseases. Epidemiological studies show significant associations between infection and inflammation and prostatic carcinoma. However, because of various confounding factors the results of these studies are inconclusive. Further findings are therefore needed to confirm the hypothesis that prostatic infection and inflammation might be a cause of prostatic carcinoma. We reviewed selected reports on the role of inflammation and infection in the pathogenesis of prostate carcinoma. Extensive genetic analyses show that several gene products, e.g. 2′-5′-oligoadenylate (2–5 A)-dependent Rnase, macrophage scavenger receptor 1 and Toll-like receptor-4, influence the susceptibility of prostate cells to infectious agents. Proliferative inflammatory atrophy (PIA) could be a connection between prostatitis and prostatic carcinoma. In the transition from PIA to prostatic intraepithelial neoplasia, the function of cellular detoxification is gradually lost by silencing of glutathione-S transferase, a detoxifying enzyme. This cellular feature leads to an increased susceptibility of the prostatic epithelial cells to genomic damage by inflammatory oxidants or nutritional carcinogens. Consecutive somatic genome damage might then arise which modulates the further pathogenesis of prostate carcinoma. Summarising these epidemiological, genetic and cell biological aspects, infectious prostatitis might have a causative role in the complex and multifactorial process of prostate carcinogenesis.

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