Chlorination by-products in drinking water and risk of bladder cancer - A population-based cohort study.

Chlorination by-products have been consistently associated with risk of bladder cancer in case-control studies, but confirmation from large-scale cohort studies is lacking. We assessed the association of drinking water trihalomethanes (THM), a proxy for chlorination by-products, with risk of bladder cancer in 58,672 men and women. Data came from two population-based cohorts, parts of the Swedish Infrastructure for Medical Population-Based Life-Course and Environmental Research (SIMPLER). Individual exposure to THM was assessed by combining residential information with tap water monitoring data. Participants were categorized into non-exposed, low (<15 µg/L) or high (≥15 µg/L) THM exposure. Incident cases were ascertained from 1998 through 2019 via register linkage. During 16 years of follow-up (965,590 person-years), 831 bladder cancer cases were ascertained. We observed no overall association of THM with risk of bladder cancer, hazard ratio for the highest exposed compared to the non-exposed 0.90 (95% confidence interval: 0.73 - 1.11). The null association remained after restricting the analysis to long-term residents and across strata of smoking status and cancer stage. Our results indicate that chlorination by-product exposure at THM concentrations representative of chlorinated drinking waters in most European countries, is not associated with an increased risk of bladder cancer.

Diagnostic outcomes from transrectal and transperineal prostate biopsies - experiences from a Swedish tertiary care Centre.

OBJECTIVE: The aim of this study was to compare diagnostic and infectious outcomes between MRI-guided transrectal (TR) and transperineal (TP) prostate biopsies, in order to evaluate implementation of local-anaesthesia TP biopsies in a Swedish university hospital setting. METHODS: In this non-randomized observational study, we recruited 105 patients who underwent TR or TP software-based MRI-ultrasound fusion prostate biopsies between April and August 2020. Information on outcome and covariates were obtained from hospital records. We compared detection rates of overall prostate cancer (PCa) and clinically significant PCa (≥ISUP2) between the two groups using simple and multivariable-adjusted analyses. As a secondary outcome, we descriptively compared infection-related outcomes between the two groups. RESULTS: Of the total population, 72 patients underwent TR and 33 patients underwent TP biopsies. Biopsies were positive for PCa in 50 (69.4%) patients of the TR group and 23 (69.7%) patients of the TP group. Clinically significant cancer was found in 28 (38.9%) patients of the TR group and 10 (30.3%) patients of the TP group. Simple and multivariable-adjusted analyses did not indicate any statistically significant difference between groups. Post-biopsy infection was diagnosed in one patient (3%) of the TP group and eight patients (11.1%) in the TR group, conforming to previous reports of low infection rates after TP biopsies. CONCLUSIONS: Our results conform to data suggesting that the transition from TR to TP MRI-guided biopsies is feasible and safe, maintaining a high diagnostic quality while possibly reducing the risk of infection-related complications.

Circulating inflammation markers and prostate cancer.

BACKGROUND: Chronic inflammation is thought to influence the risk of prostate cancer. The purpose of this population-based case-control study was to evaluate the association of 48 circulating inflammation markers with prostate cancer, to identify candidate markers for further investigation. METHODS: Serum samples collected from 235 prostate cancer patients and 198 population-based controls recruited in Örebro County, Sweden, in 1989-1991, were assessed using a multiplex bead-based immunoassay to determine concentrations of 48 circulating inflammation markers. Logistic regression was first used to evaluate the association between individual markers (highest vs lowest concentration quartile) and prostate cancer in unadjusted and mutually adjusted models. Second, patients with inflammatory conditions, metastatic or advanced prostate cancer, were excluded to address the possible influence of systemic disease on inflammation markers. RESULTS: Individual analyses first identified 21 markers associated with prostate cancer (P < .05), which after mutual adjustment were reduced to seven markers. After the exclusion of men with conditions linked with systemic inflammation, associations between prostate cancer and deviant levels of C-X3-C motif chemokine ligand 1, platelet-derived growth factor subunit B homodimer, interleukin 10, C-C motif chemokine ligand (CCL) 21, and CCL11 remained statistically significant. CONCLUSIONS: In this explorative study, we identified candidate inflammation markers of possible importance for prostate cancer pathophysiology, for further evaluation in prospective studies.

The influence of prostatic Cutibacterium acnes infection on serum levels of IL6 and CXCL8 in prostate cancer patients.

BACKGROUND: Chronic prostatic inflammation, caused by Cutibacterium acnes (C. acnes), has been proposed to influence the risk of prostate cancer development. In vitro studies have demonstrated the capacity of C. acnes to induce secretion of Interleukin 6 (IL6) and C-X-C motif chemokine ligand 8 (CXCL8) by prostate epithelial cells. Both these inflammatory mediators have been implicated in prostate cancer pathophysiology. In this cohort study, we aimed to investigate the influence of prostatic C. acnes on serum levels of IL6 and CXCL8. METHODS: We recruited 99 prostate cancer patients who underwent radical prostatectomy at Örebro University Hospital. The cultivation of pre-operatively obtained prostate biopsies identified C. acnes in 60 of the 99 patients. Levels of IL6 and CXCL8 in pre-operative serum samples were analyzed using ELISA, and concentrations were compared between prostate cancer patients with and without prostatic C. acnes infection using standard statistical methods. RESULTS: No statistical differences were observed in serum levels of IL6 and CXCL8 between subjects with and without prostatic C. acnes infection. CONCLUSIONS: Our results indicate that prostatic C. acnes infection may give rise to low-grade inflammation with little effect on systemic levels of IL6 and CXCL8.

Appendicitis before Age 20 Years Is Associated with an Increased Risk of Later Prostate Cancer.

Background: Appendicitis before age 20 years has been observed to influence the risk of several inflammatory conditions, possibly through underlying immunological mechanisms. Inflammation has further been suggested to be involved in prostate cancer development. We therefore hypothesized that immunological characteristics signaled by appendicitis before late adolescence might influence the risk of later prostate cancer, and aimed to evaluate this association in a population-based study.Methods: We identified a large cohort of Swedish men who underwent assessment for military conscription around the age of 18 years (n = 242,573). Medical diagnoses at time of conscription were available through the Swedish Military Conscription Register. The Swedish Cancer Register was used to identify diagnoses of prostate cancer. Multivariable adjusted Cox regression analyses were used to estimate HR and 95% confidence intervals (95% CIs) for the association between appendicitis and prostate cancer.Results: During a median of 36.7 years of follow-up, 1,684 diagnoses of prostate cancer occurred. We found a statistically significant association between appendicitis and overall prostate cancer (adjusted HR 1.70; 95% CI, 1.08-2.67). The risk was notably increased for advanced (HR 4.42; 95% CI, 1.74-11.22) and lethal (HR 8.95; 95% CI, 2.98-26.91) prostate cancer.Conclusions: These results suggest that a diagnosis of appendicitis before adulthood potentially signals underlying immune characteristics and a pattern of inflammatory response relevant to prostate cancer risk.Impact: The study lends support to the proposed role of inflammation in prostate carcinogenesis, and adds another area of investigation potentially relevant to prostate cancer development. Cancer Epidemiol Biomarkers Prev; 27(6); 660-4. ©2018 AACR.

Acne in late adolescence and risk of prostate cancer.

Accumulating evidence suggest that Propionibacterium acnes may play a role in prostate carcinogenesis, but data are so far limited and inconclusive. The aim of this population-based cohort study was therefore to test whether presence of acne vulgaris during late adolescence is associated with an increased risk of prostate cancer later in life. We identified a large cohort of young men born in Sweden between 1952 and 1956, who underwent mandatory assessment for military conscription around the age of 18 (n = 243,187). Test information along with health data including medical diagnoses at time of conscription was available through the Swedish Military Conscription Register and the National Patient Register. The cohort was followed through linkages to the Swedish Cancer Register to identify the occurrence of prostate cancer until December 31, 2009. We used Cox regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between acne in adolescence and prostate cancer risk. A total of 1,633 men were diagnosed with prostate cancer during a median follow-up of 36.7 years. A diagnosis of acne was associated with a statistically significant increased risk for prostate cancer (adjusted HR: 1.43 95%; CI: 1.06-1.92), particularly for advanced stage disease (HR: 2.37 95%; CI 1.19-4.73). A diagnosis of acne classified as severe conferred a sixfold increased risk of prostate cancer (HR: 5.70 95% CI 1.42-22.85). Data from this large prospective population-based cohort add new evidence supporting a role of P. acnes infection in prostate cancer.