Today, current methods of prostate cancer detection, such as the prostate-specific antigen (PSA) test, often fail to identify which cancers will prove fatal and which cancers will remain benign until a patient dies of other causes.

?We are in need of better markers that distinguish between aggressive and indolent disease in this population,? said Jennifer R. Rider, Sc.D., an instructor in medicine at the Brigham and Women?s Hospital, Harvard Medical School in Boston, Mass.

A more precise prognosis
In a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, Rider and colleagues suggested that levels of prostatic intraepithelial neoplasia (PIN) could allow for a more precise prognosis.

The researchers evaluated men with localized prostate cancer diagnosed following a surgical procedure to treat benign prostatic hyperplasia. Of these men, 228 died of prostate cancer and 387 were diagnosed with prostate cancer, but were still alive after 10 years. Those with PIN were 89% more likely to die of prostate cancer.

Chronic inflammation
Even after accounting for age, Gleason score, year of diagnosis, inflammation and type of focal atrophy present, PIN still managed to independently predict the lethality of a given tumor. There was also a suggestion that the degree of chronic inflammation adjacent to the tumor could predict lethal outcome.

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Understanding the biology
?Identifying features surrounding the tumor that can predict prognosis, such as the presence of PIN or inflammation, can improve our understanding of the biology of aggressive prostate cancer and help to guide clinical decision-making,? said Rider.

The study was funded by the United States Department of Defense, the National Institutes of Health, the Prostate Cancer Foundation and the Swedish Cancer Society.

For more information:
Davidsson S, Fiorentino M, Andr?n O, Fang F, Mucci LA, Varenhorst E, Fall K, Rider JR. Inflammation, Focal Atrophic Lesions, and Prostatic Intraepithelial Neoplasia with Respect to Risk of Lethal Prostate Cancer. Cancer Epidemiol Biomarkers Prev October 2011 20; 2280. Published OnlineFirst September 27, 2011.

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