Proliferative inflammatory atrophy (pia) as a possible new precursor of prostatic cancer

Alek Popović1, Danijel Justinić1, Goran Štimac1, Šoip Šoipi1, Davor Tomas2, Davor Trnski1,

University Department of Urology1, „Ljudevit Jurak“ University Department of Pathology2, Sestre milosrdnice University Hospital Center, Zagreb, Croatia


Background: Recent studies suggest association of chronic prostatic inflammation and proliferative inflammatory atrophy (PIA) which could also be involved in the pathogenesis of prostatic carcinoma. As subclinical prostatic inflammation has significant effect on PSA values, thus biochemically imitating cancer, a significant proportion of men might be subjected to unnecessary repeated prostate biopsies (PB). It is not clear whether the inflammation and PIA in the PB findings should be interpreted as harmless or as inducer of carcinogenesis and indication for careful monitoring and repeated PB.

Aim: The aim of our study was to assess the risk for prostatic cancer detection in patients who were diagnosed with inflammatory changes and PIA on the initial biopsy screening and are performing repeated PB.

Patients and methods: The study included 208 consecutive patients (PSA values ​​≤10 ng/ml) screened for prostatic cancer at the University Department of Urology, “Sestre milosrdnice” University Hospital Center, from January 2003rd till November 2008th. In all patients with initial PB showing inflammatory changes and PIA, repeated PB was performed.

Results: Initial PB showed inflammatory changes in 94.2% and PIA in 39.4% patients, PIA was mostly present simultaneously with chronic inflammatory changes (88.2%). Repeated PB was negative for prostatic cancer in 12.5% patients. Patients diagnosed with prostatic cancer on repeated PB, significantly more often had PIA on initial PB ((p <0.001). Kaplan-Meier analysis showed increased risk of prostatic cancer in patients diagnosed with PIA on initial biopsy.

Conclusions: Our results indicate that presence of PIA in initial PB correlates well with increased risk of developing prostatic cancer, suggesting a possible role of both PIA and inflammatory changes in prostatic cancer pathogenesis. In clinical decision upon negative initial PB, recognition of those entities indicates the need for repeated PB, thus enabling earlier detection and treatment of prostatic cancer.