Men with inflammatory bowel disease may be at a greater risk of prostate cancer when compared to men in the general population, according to data recently published in European Urology.
“Patients with IBD have an increased risk of gastrointestinal malignancy, as well as certain extra-intestinal malignancies,” Jacob A. Burns from the department of urology at Northwestern University Feinberg School of Medicine in Chicago, IL and colleagues wrote in the study. “There are limited data describing the risk of PCa in men with IBD and no reports comparing PSA levels in men with and without IBD.”
Male patient looking at clipboard with doctor. Source: Getty
In order to compare the incidence of PCa between men with and without IBD, Burns and colleagues conducted a 10,339-patient retrospective, matched-cohort study at a single academic medical center, taking place between 1996 and 2017.
A total of 1,033 male patients with IBD were randomly matched 1:9 by age and race to a control group made up of 9,306 men without IBD.
Patients who met the inclusion criteria had undergone at least one prostate-specific antigen (PSA) screening test.
Burns and colleagues used Kaplan-Meier and multivariable Cox proportional hazard models, stratified by age and race, to evaluate the relationship between IBD and the incidence of any PCa and clinically significant PCa (Gleason grade group ≥2), as well as a mixed-effect regression model to assess the link between IBD and PSA level.
At ten years the researchers found PCa incidence of 4.4% among men with IBD and 0.65% among controls (HR = 4.84 [3.34–7.02] [3.19–6.69], P < .001).
The rate of clinically significant PCa incidence at 10 years was 2.4% for men with IBD and 0.42% for controls (HR = 4.04 [2.52–6.48], P < .001).
After approximately age 60, PSA values were higher among patients with IBD (fixed-effect interaction of age and patient group: P = 0.004). While previous studies have found that subtle elevations in PSA above the age-specific median level are predictive of increased rates of PCa and advanced PCa, the findings by Burns et al. highlight the important role of investigating the benefits and harms of PCa screening in high-risk populations.
According to the researchers, prospective studies are necessary due to the limitations of the study based on the retrospective nature of the analysis and lack of external validity.
“The prevalence of PCa and the morbidity associated with both PCa and its treatment necessitate shared decision-making regarding PSA-based screening,” the researchers wrote. “Factors influencing either the risk of PCa or serum PSA values may have implications for the shared decision-making process.”