OBJECTIVES: The exact pathogenesis of benign prostatic hyperplasia (BPH) and related lower urinary tract symptoms (LUTS) remains unclear; however evidence supports a role of inflammation.
One possible source of prostatic inflammation is sexually transmitted infections (STIs), which have been found to be positively related to LUTS in some mostly small case-control studies or cross-sectional surveys. The objective of our analysis is to examine whether a history of STIs or positive STI serology is associated with prevalent and incident BPH/LUTS-related outcomes in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).
METHODS: Self-reported history of STIs (gonorrhea, syphilis) was ascertained at baseline, and serological evidence of STIs (Chlamydia trachomatis, Trichomonas vaginalis, HPV-16, HPV-18, HSV-2, HHV-8, and CMV) was detected in baseline serum specimens. We used data collected on the baseline questionnaire, as well as results from the baseline PSA test and digital rectal exam (DRE), to define prevalent BPH/LUTS-related outcomes as evidence of LUTS (self-reported diagnosis of an enlarged prostate/BPH, BPH surgery, or nocturia (waking ≥2 times/night to urinate)) and evidence of prostate enlargement (PSA>1.4 ng/mL or prostate volume ≥30 cc) in men without prostate cancer. We created a similar definition of incident BPH using data from the follow-up questionnaire completed 5-13 years after enrollment (self-reported diagnosis of an enlarged prostate/BPH or nocturia), data on finasteride use during follow-up, and results from the follow-up PSA tests and DREs. We used Poisson regression with robust variance estimation to calculate prevalence ratios (PRs) in our cross-sectional analysis of self-reported (n=32,900) and serologically-detected STIs (n=1,143) with prevalent BPH/LUTS, and risk ratios in our prospective analysis of self-reported STIs with incident BPH/LUTS (n=5,226).
RESULTS: Generally null results were observed for a self-reported history of STIs and positive STI serologies with prevalent and incident BPH/LUTS-related outcomes, with the possible exception of T. vaginalis infection. This STI was positively associated with prevalent nocturia (PR 1.36, 95% confidence interval (CI): 1.18-1.65), prevalent large prostate volume (PR 1.21 95% CI 1.02-1.43), and any prevalent BPH/LUTS (PR 1.32 95% CI 1.09-1.61); too few men had information on both STI serologies and incident BPH/LUTS to investigate associations between T. vaginalis infection and incident BPH/LUTS-related outcomes.
CONCLUSIONS: Our findings do not support associations of several known STIs with BPH/LUTS-related outcomes, although T. vaginalis infection may warrant further study.
Written by:
Breyer BN, Huang WY, Rabkin CS, Alderete JF, Pakpahan R, Beason TS, Kenfield SA, Mabie J, Ragard L, Wolin KY, Grubb Iii RL, Andriole GL, Sutcliffe S. Are you the author?
University of California San Francisco, Department of Urology, San Francisco, CA.
Reference: BJU Int. 2015 Jan 20. Epub ahead of print.
doi: 10.1111/bju.13050
PubMed Abstract
PMID: 25601300