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Gonorrhea, Syphilis, Clinical Prostatitis, and the Risk of Prostate Cancer

¹ Department of Epidemiology, Bloomberg School of Public Health; ² James Buchanan Brady Urological Institute and the Sidney Kimmel Comprehensive Cancer Center; ³ Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; ⁴ Departments of Nutrition and Epidemiology, Harvard School of Public Health and the Channing Laboratory, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Boston, Maryland; and ⁵ Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland

Requests for reprints: Elizabeth A. Platz, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Room E6138, 615 North Wolfe Street, Baltimore, MD 21205. Phone: 410-614-9674; Fax: 410-614-2632. E-mail: eplatz{at}jhsph.edu

Background: Although previous case-control studies have observed positive associations among gonorrhea, syphilis, clinical prostatitis, and prostate cancer, many may have been susceptible to recall and interviewer biases due to their retrospective designs. Therefore, to investigate these associations without concerns of recall and interviewer biases, we conducted a large, prospective investigation in the Health Professionals Follow-up Study.

Methods: In 1992, participants were asked to report their histories of gonorrhea, syphilis, and clinical prostatitis by mailed questionnaire. Prostate cancer diagnoses were ascertained by self-report on the 1994 and each subsequent biennial follow-up questionnaire and confirmed by medical record review.

Results: Of the 36,033 participants in this analysis, 2,263 were diagnosed with prostate cancer between the date of return of the 1992 questionnaire and 2002. No association was observed between gonorrhea [adjusted relative risk (RR), 1.04; 95% confidence interval (95% CI), 0.79-1.36] or syphilis (RR, 1.06; 95% CI, 0.44-2.59) and prostate cancer. Overall null results were also observed between clinical prostatitis and prostate cancer (RR, 1.08; 95% CI, 0.96-1.20), although a significant positive association was observed among younger men (<59 years) screened for prostate cancer (RR, 1.49; 95% CI, 1.08-2.06; P_interaction = 0.006).

Conclusions: Gonorrhea and syphilis do not seem to be risk factors for prostate cancer in this cohort of men with a lower burden of sexually transmitted infections. Clinical prostatitis is also unlikely to be a risk factor, although possible roles for prostatitis in younger men and asymptomatic prostatic infection and inflammation cannot be ruled out. (Cancer Epidemiol Biomarkers Prev 2006;5(11):2160–6)

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