A SYSTEMATIC REVIEW AND META-ANALYSIS OF ASSOCIATIONS BETWEEN CLINICAL PROSTATITIS AND PROSTATE CANCER: NEW ESTIMATES ACCOUNTING FOR DETECTION BIAS

Background: Previous meta-analyses have estimated summary positive associations between clinical prostatitis and prostate cancer. However, none have accounted for detection bias, the possibility for increased prostate cancer screening and detection in men with clinical prostatitis, in their pooled estimates. Methods: We searched for studies that investigated the relation between clinical prostatitis and prostate cancer through November 2018. Random effects meta-analysis was used to calculate summary odds ratios (OR) among all studies and in strata defined by methods used to reduce detection bias. Results: Although an increased odds of prostate cancer was seen among men with a history of clinical prostatitis in all 38 eligible studies combined [OR, 2.05; 95% confidence interval (CI), 1.64–2.57], this estimate attenuated to null among studies that performed the most rigorous analyses to limit detection bias (OR, 1.16; 95% CI, 0.77–1.74). Conclusions: Our findings indicate that previously reported positive associations between clinical prostatitis and prostate cancer are likely due to detection bias. Impact: Studies using rigorous detection bias methods are warranted to replicate these findings, as well as to examine the possible relation between prostate inflammation and prostate cancer directly, rather than indirectly through the diagnosis of “prostatitis,” which includes a large proportion of men without evidence of prostate inflammation.