Benign Prostatic Hyperplasia Doubles Risk of Prostate Cancer

Zosia Chustecka

September 24, 2011

September 24, 2011 — The largest registry study so far has found a significant association between benign prostatic hyperplasia (BPH) and prostate cancer. The finding was reported here at the 2011 European Multidisciplinary Cancer Congress by Danish researchers, and comes from an analysis of data from more than 3 million men.

The results show that men who were hospitalized for BPH had double the risk of developing prostate cancer as those in the general population; those who underwent surgery for their BPH had treble their risk. In addition, the risk of dying from prostate cancer rose significantly — 2-fold among those hospitalized for BPH and up to 8-fold among those who underwent surgery, reported Stig Bojesen, MD, from Copenhagen University Hospital, Herlev, Denmark.

This is an extremely controversial hot topic.

"This is an extremely controversial hot topic," said Cora Sternberg, MD, chief of medical oncology at the San Camillo/Forlanini Hospital in Rome, Italy, who acted as a discussant for this paper. She noted that several previous studies have not shown any association between BPH and prostate cancer, whereas others have hinted at such a link; a recent study found that the 2 conditions are biologically homogeneous.

These data do not infer a causality.

The Danish study found a significant association, but "these data do not infer a causality," she emphasized. More work is needed, she said.

The suggestion that BPH raises the risk for prostate cancer is very controversial, said Joaquim Bellmunt, MD, from the Valle d'Hebron University Hospital, Barcelona, Spain, who chaired the session. Nearly all men develop some BPH with age, so the suggestion that this condition increases the risk for prostate cancer could provoke great fear and anxiety among the general public, he told Medscape Medical News. "We need to be very cautious and study this further," he added.

Data on More Than 3 Million Men

Dr. Stig Bojesen

Dr. Bojesen and colleagues analyzed data on 3,009,258 men from several separate Danish registries (such as on hospitalization, surgery, cause of death, prescriptions, and the national cancer registry). Follow-up was up to 27 years.

The team found that from 1980 to 2006, there were 853,315 men diagnosed with prostate cancer, and 25,459 died from the disease. Hospitalization for clinical BPH was required by 187,591 men, and BPH was treated with surgery in 77,698.

A multivariate analysis found that men who were hospitalized for BPH were twice as likely to be diagnosed with prostate cancer as the general population (hazard ratio [HR], 2.22; 95% confidence interval [CI], 2.13 to 2.31), and were also twice as likely to die from prostate cancer (HR, 2.00; 95% CI, 1.91 to 2.08). Men who underwent surgery for BPH were 3 times more likely to be diagnosed with prostate cancer (HR, 3.36; 95% CI, 3.03 to 3.50) and nearly 8 times more likely to die from prostate cancer (HR, 7.85; 95% CI, 7.40 to 8.32).

These are "consistent results showing an association," said Dr. Bojesen.

He emphasized that this was a retrospective epidemiologic study, and that although the results show an association between the 2 conditions, this study does not suggest that the association is causal. When pressed, however, he added that BPH results in an "enlarged organ," and so an association with prostate cancer is "likely."

Jean-Charles Soria, MD, from the Institut Gustave Roussy, Paris, France, who was moderating the press conference at which the study was featured, noted that the association with prostate cancer was found for men with BPH who had been hospitalized or operated on, which would suggest a more serious condition, and not for men who had milder BPH that was not treated. "That makes me think that there might be some causality there," he said. However, he pointed out that there have been other studies that have found no association.

Although acknowledging that more work is needed, Dr. Bojesen suggested that the results from this study already have important implications, considering how many people are affected.

"The possible clinical implication of our study might be that physicians treating men with benign prostatic hyperplasia should follow these men carefully to ensure early diagnosis and treatment of a possible prostate cancer, thereby enhancing the chance of curative treatment," he said.

"However, our study does not allow us to suggest the optimal surveillance program for these men," he added. "This question should be addressed in further studies."

Dr. Bojesen has disclosed no relevant financial relationships.

2011 European Multidisciplinary Cancer Congress (EMCC): Abstract 7102. Presented September 24, 2011.

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