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The association between prostatitis and prostate cancer. Systematic review and meta-analysis

Gianpaolo Perletti, Elena Monti, Vittorio Magri, Tommaso Cai, Anne Cleves, Alberto Trinchieri, Emanuele Montanari
  • Elena Monti
    Università degli Studi dell’Insubria Department of Biotechnology and Life Sciences, Busto A., Italy
  • Vittorio Magri
    Urology Secondary Care Clinic, ASST-Nord, Milan; Department of Urology, University of Milan Fondazione Ca' Granda IRCCS - Ospedale Maggiore Policlinico, Milan, Italy
  • Tommaso Cai
    Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
  • Anne Cleves
    Velindre NHS Trust Library, Cardiff University, Velindre Cancer Centre, Cardiff, United Kingdom
  • Alberto Trinchieri
    Urology Unit, A. Manzoni Hospital, Lecco, Italy
  • Emanuele Montanari
    Department of Urology, University of Milan Fondazione Ca' Granda IRCCS - Ospedale Maggiore Policlinico, Milan, Italy

Abstract

Objective: The main outcome of this review was the association between a history of clinical chronic prostatitis (NIH category II or III) and a histologically confirmed diagnosis of prostate cancer. Materials and methods: Crude odds ratios and 95% confidence intervals (CI) were calculated to analyze dichotomous data. For analysis of pooled data we adopted a random-effects model and the inverse variance weighing method. Heterogeneity was assessed by calculating the I2 value. Results: Out of 2794 screened records, we retrieved 16 full-text articles written in English, reporting the data of 15 case-control studies, involving 422.943 patients. Pooled analysis resulted in a significant crude odds ratio of 1.83 (95% CI: 1.43 to 2.35; P < 0.00001). The total set of data showed considerable heterogeneity (I2 = 91%). Both the Egger’s test and the Begg's test for funnel plot asymmetry did not reach statistical significance. The ‘trim and fill’ method applied to the funnel plot imputed 3 missing studies and the resulting adjusted estimate of the odds ratio was 2.12 (95% CI: 1.38 to 3.22). According to GRADE criteria, the overall quality of the meta-analysis data is low, mainly due to the presence of bias, confounders and extreme effect size outliers. Five among the included studies reported data assessed in 8015 African-American subjects. Pooled analysis resulted in a non-significant crude odds ratio of 1.59 (95% CI: 0.71 to 3.57; P = 0.26), and considerable heterogeneity (I2 = 90%). Conclusions: Meta-analysis of 15 case-control studies shows that a history of clinical chronic prostatitis can significantly increase the odds for prostate cancer in the general population, whereas such association in African-American individuals remains uncertain.

Keywords

Prostate cancer; Prostatitis; Chronic prostatitis; Chronic pelvic pain syndrome; Meta-analysis; Case-control study

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Submitted: 2017-07-13 16:42:03
Published: 2017-12-31 00:00:00
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Copyright (c) 2018 Gianpaolo Perletti

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