CPPS and Prostate Cancer

Even some urologists are confused about this one!

A 1999 study of prostate biopsies of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients found no cancer cells, and the authors commented that this was unusual:

“A final observation deserves comment. In our relatively large patient cohort we expected to find some incidental cancers of the prostate but none was noted …”.

pcancThe same study found that only 5% of CPPS patients had moderate or severe prostatic inflammation. However, histological (microscopic) inflammation is a frequent finding in prostate cancer studies. And while prostates removed because of cancer may show signs of focal inflammation, the owners of those glands are unlikely to have suffered from chronic pelvic pain.

Anecdotally, there are no mentions of cancer on our forum, where thousands of men with CPPS have shared their cases.

Inflammation is also a frequent finding in BPH. This inflammation is theorized to result from the endocrine-driven overgrowth of the gland leading to small ruptures in the tubules which allow secretions to “leak” into the tissues of the gland and cause inflammatory reactions. Again, the mild inflammation and discomfort of BPH does not rise to the level of severity of true chronic pelvic pain syndrome (which can be disabling), although the possibility of developing chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) as a result of BPH may exist, in the susceptible.

There is now also some science to show a faintly negative correlation between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and prostate cancer. PSA is often raised in CPPS/chronic prostatitis patients. Here is an interesting study suggesting the actual PSA protein may inhibit prostate cancer. As prostatitis researcher Daniel Shoskes MD says, perhaps CP/CPPS/chronic prostatitis –> increased PSA –> decreased chance of prostate cancer (or at least its rapid progression):

PSA may slow progression of prostate cancer

October, 1999 — Prostate-specific antigen (PSA), the protein measured in the widely used blood test for prostate cancer, may slow the growth of prostate cancer by preventing the formation of new blood vessels, US researchers report in the October 6th issue of the Journal of the National Cancer Institute. The findings “call into question various strategies to inhibit the expression of PSA in the treatment of prostate cancer,” the team suggests.

Increasing PSA concentrations “may not be a harbinger of bad news and prostate cancer progression but, rather, may indicate that the body is attempting to fight cancer by producing its own antiangiogenic proteins,” write Dr. Anne Fortier and her coworkers from EntreMed, Inc., a Rockville, Maryland corporation.

The investigators examined the effects of PSA on three different steps in the angiogenesis process using cells grown in the laboratory. Their results indicate that PSA inhibits the growth and spread of new blood vessel cells in all three steps, but has no effect on the growth of skin cancer or prostate cancer cells.

Furthermore, in mice with melanoma, an aggressive type of skin cancer, administration of PSA prevented the spread (metastasis) of melanoma to distant sites within the mice, Fortier and colleagues report.

“These data suggest,” the researchers note, “that the production of PSA by prostate cancers is one reason for their characteristically slow growth.” The investigators call into question efforts that are underway to create vaccines against PSA, in light of their discoveries.

On the contrary, they suggest that “the administration of PSA as a drug to augment (the body’s own) concentrations could provide a rational therapeutic approach in the treatment of cancer.”

SOURCE: Journal of the National Cancer Inst

Finally, a 2000 study (Prostate blood flow characteristics in chronic prostatitis/chronic pelvic pain syndrome. Krieger et al) found that:

“Chronic prostatitis/CPPS was associated with increased blood flow to the prostatic capsule and diffusely throughout the prostatic parenchyma.”

This study shows that chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients have increased blood flow to the prostate, further mitigating against cancer by flooding the area with immune system cells, one of the functions of which is to destroy cancer. This is supported by a recent study (Human Gene Therapy 2001;12:883-892) by Dr. Arie Belldegrun and colleagues in which prostate cancer is deliberately fought by raising the presence of immune cells in the gland:

Injecting a gene that produces a cancer-fighting chemical directly into a tumor may help treat prostate cancer patients, according to researchers from UCLA School of Medicine in Los Angeles, California.

The chemical, interleukin 2 (IL-2), is one of the most powerful antitumor chemicals produced by the body, but giving it at doses needed to control cancer can cause severe side effects.

For that reason, Dr. Arie Belldegrun and colleagues delivered an IL-2 producing gene directly into the site of prostate cancer in 24 patients, focusing on possible side effects and hoping for some evidence of a beneficial effect. “This is the first immune- based gene therapy study in prostate cancer,” Belldegrun told Reuters Health.

Gene therapy brought a significant influx of immune cells into the tumor during the first 2 weeks after treatment, the authors report, and increased activation of the immune system followed gene injection.

“Stimulating your own immune system to destroy cancer is an attractive approach with minimal side effects,” Belldegrun added. ”Gene therapy is in its early stages but studies such as these will help clarify its role in cancer patients.”