Findings from a first-of-its-kind study implicate pelvic inflammation as a driver of prostate cancer progression and recurrence after robot-assisted laparoscopic prostatectomy (RALP).
The study is the first to examine the effect of pelvic inflammation on prostate cancer biology and outcomes. Investigators found that high pelvic inflammation in men who underwent RALP was associated with elevated expression of inflammation-associated genes and cancer-driving pathways in their tumors. Tissue analyses suggest involvement of the pro-inflammatory cytokines interleukin-6 (IL-6) and STAT 3.
“The study’s findings of an association between pelvic inflammation and [prostate cancer] recurrence raise many interesting questions for future research,” first author Dimple Chakravarty, PhD, of the Icahn School of Medicine at Mount Sinai in New York, New York, said in a prepared statement. “Importantly, it does not suggest that pelvic inflammation alone causes [prostate cancer]; pelvic inflammation exacerbates the progression of the pre-existing disease and may drive an aggressive phenotype.”
In a retrospective study, Dr Chakravarty and colleagues analyzed data from 2085 men who underwent RALP from January 2013 to October 2019 at a single institution to examine the association between pelvic inflammation and adverse pathology, defined as Gleason Grade Group higher than 2 and stage pT3 or higher disease. They looked at the association between pelvic inflammation and biochemical recurrence (BCR) in a subset of 1997 patients.
A high level of pelvic inflammation was significantly more common among men who had adverse pathology compared with those who did not (47.6% vs 34.4%). In multivariate analyses, high pelvic inflammation was significantly associated with a 29% increased risk for BCR and PSA persistence and 32% increased risk for BCR alone. Men with high pelvic inflammation had elevated systemic levels of pro-inflammatory cytokines in their blood. Quantitative reverse transcription polymerase chain reaction (RT-PCR) analysis of inflamed pelvic tissue taken during surgery “suggested that systemic pro-inflammatory cytokines detected in the blood were potentially released from these inflamed sites into the systemic circulation.” The investigators reported finding high levels of IL-6 and STAT3 in inflamed tissues and prostate tissue.
“Until now, chronic inflammation within the prostate was considered a significant contributor to prostate cancer progression,” senior author Ashutosh Tewari, MD, chair of urology for the Mount Sinai Health System, said in the statement. “However, our studies, for the first time, demonstrate that inflammation away from the prostate could be equally important. Therefore, managing inflammation in high-risk prostate cancer patients is critical and could be achieved by diet and other intervention strategies.”
Chakravarty D, Ratnani P, Huang L, et al. Association between incidental pelvic inflammation and aggressive prostate cancer. Cancers. 2022;14(11):2734. doi:10.3390/cancers14112734