title: Inflammation, focal atrophic lesions, and prostatic intraepithelial neoplasia with respect to risk of lethal prostate cancer.
abstract: BACKGROUND
  A challenge in prostate cancer (PCa) management is identifying potentially lethal disease at diagnosis. Inflammation, focal prostatic atrophy, and prostatic intraepithelial neoplasia (PIN) are common in prostate tumor specimens, but it is not clear whether these lesions have prognostic significance.
  
  
  METHODS
  We conducted a case-control study nested in a cohort of men diagnosed with stage T1a-b PCa through transurethral resection of the prostate in Sweden. Cases are men who died of PCa (n = 228). Controls are men who survived more than 10 years after PCa diagnosis without metastases (n = 387). Slides were assessed for Gleason grade, inflammation, PIN, and four subtypes of focal prostatic atrophy: simple atrophy (SA), postatrophic hyperplasia (PAH), simple atrophy with cyst formation, and partial atrophy. We estimated OR and 95% CI for odds of lethal PCa with multivariable logistic regression.
  
  
  RESULTS
  Chronic inflammation and PIN were more frequently observed in tumors with PAH, but not SA. No specific type of atrophy or inflammation was significantly associated with lethal PCa overall, but there was a suggestion of a positive association for chronic inflammation. Independent of age, Gleason score, year of diagnosis, inflammation, and atrophy type, men with PIN were 89% more likely to die of PCa (95% CI: 1.04-3.42).
  
  
  CONCLUSIONS
  Our data show that PIN, and perhaps presence of moderate or severe chronic inflammation, may have prognostic significance for PCa.
  
  
  CONCLUSIONS
  Lesions in tumor adjacent tissue, and not just the tumor itself, may aid in identification of clinically relevant disease.
authors.affiliation: Department of Urology, Örebro University Hospital, Örebro, Sweden. sabina.davidsson@orebroll.se
authors.forename: Sabina
authors.initials: S
authors.lastname: Davidsson
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.forename: Ove
authors.initials: O
authors.lastname: Andrén
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Lorelei A
authors.initials: LA
authors.lastname: Mucci
authors.forename: Eberhard
authors.initials: E
authors.lastname: Varenhorst
authors.forename: Katja
authors.initials: K
authors.lastname: Fall
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Rider
mesh_terms: D001284:Atrophy / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000473:pathology*; D008297:Male; D060787:Neoplasm Grading; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000473:pathology*; D019048:Prostatic Intraepithelial Neoplasia / Q000150:complications / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors; D013548:Sweden