Genitourinary Infections, Sexually Transmitted Infections And Prostate Cancer Risk: The EPICAP Study

Miguelle MAROUS, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, France
CÉNÉE S. 1 , RÉBILLARD X. 2 , TRÉTARRE B. 3 , SANCHEZ M. 1 , MENEGAUX F. 1

1 CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
2 Service Urologie, Clinique Beau Soleil, Montpellier, France
3 Registre des Tumeurs de l’Hérault, Montpellier, France

Purpose: Epidemiological studies have suggested that genitourinary infections (GUIs) and sexually transmitted infections (STIs) increase prostate cancer (PCa) risk. Chronic inflammation may explain these associations. We investigated the role of GUIs and STIs in the occurrence of PCa in the EPICAP study.
Methods: EPICAP is a population-based case-control study conducted in the département of Hérault, France between 2012 and 2014. All men residents in this département aged less than 75 years old who were newly diagnosed with a PCa were eligible to the study. Population controls were frequency-matched by 5-year age group to the cases. A total of 819 incident PCa cases and 879 controls were included. An in-person interview was conducted using a standardized questionnaire to obtain information on recognized or suspected risk factors for prostate cancer, as well as on history of GIUs (prostatitis, urethritis, orchi-epididymitis or acute pyelonephritis) and STIs (Gonorrhea, Trichomoniasis, Syphilis and other STIs). Odds Ratios (ORs) and their 95% Confidence Intervals (CIs) were estimated using multivariate unconditional logistic regression.
Results: Overall, 139 (18%) cases and 98 (12%) controls reported at least one GUI (OR=1.63, 95%CI, 1.22-2.17). The risk of PCa increased with the number of GUIs: OR=1.56, 95%CI, 1.15-2.13 for one and OR=2.47, 95%CI, 1.05-5.82 for two or more. Prostatitis and acute pyelonephritis were significantly associated with PCa (OR=1.53, 95%CI, 1.07-2.17 and OR=2.62, 95%CI, 1.27-5.42, respectively) while urethritis and orchi-epididymitis were not (OR=1.20, 95%CI, 0.65-2.22, OR=1.53, 95%CI, 0.87-2.69, respectively). Seven percent of the cases (n=58) and eight percent of the controls (n=72) reported a history of at least one STI (OR=0.79, 95%CI, 0.54-1.15).
Conclusions: Our results suggested that genitourinary infections, especially prostatitis and acute pyelonephritis, may play a role in the occurrence of PCa. The observed dose-response relationship supports the hypothesis of a role of chronic inflammation in prostate carcinogenesis.
Funding: LNCC, FDF, ANSES