Issue 04

Clinical Question

Does IBD increase the risk of prostate cancer?

Editor’s Bottom Line

IBD in men appears to be associated with an increased risk of prostate cancer. More information about IBD phenotype and distribution and its impact on prostate-specific antigen (PSA) levels would help our understanding of potential mechanisms.

Reference

Burns JA, Weiner AB, Catalona WJ, et al. Inflammatory Bowel Disease and the Risk of Prostate Cancer. Eur Urol. Epub Dec 4, 2018; https://doi.org/10.1016/j.eururo.2018.11.039

Synopsis

Researchers at Northwestern Medicine in Chicago retrospectively analyzed data from all patients who had undergone PSA screening at their institution between 1996 and 2014. The study population included 1,033 patients with IBD who were matched by age and race with 9,306 individuals without IBD. Both IBD and non-IBD patients were a mean 53 years of age at the time of first PSA test.

The investigators found PSA values were significantly higher among IBD patients older than 60 years of age, compared to non-IBD patients in the same age group (P=0.004). Rates of prostate cancer at five and 10 years after first PSA screening were 2.8% and 4.4% among IBD patients, respectively, and 0.25% and 0.65% for non-IBD patients (P<0.001). The number of clinically significant cases of prostate cancer were also higher among IBD patients, at 1.6% and 2.4% at five and 10 years after first PSA screening, respectively, compared to 0.17% and 0.42% at the same time points for non-IBD patients (P<0.001). Statistical analyses confirmed IBD patients had a nearly five-fold increased risk of prostate cancer and a four-fold increased risk of clinically significant prostate cancer (Hazard Ratio [HR], 4.84; 95% Confidence Interval [CI], 3.34–7.02; P<0.001 for all prostate cancers; HR, 4.04; 95% CI, 2.52–6.48; P<0.001 for clinically significant prostate cancer).

IBD duration, use of biologic drugs, a history of bowel resection and a diagnosis of ulcerative colitis versus Crohn’s disease did not affect the correlation between IBD and prostate cancer.

Details

Study Design: Retrospective cohort study
Funding: No external funding
Allocation: Control-matched
Setting: Single-center
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.