title: A case-cohort study of human herpesvirus 8 seropositivity and incident prostate cancer in Tobago.
abstract: BACKGROUND
  We previously reported a cross-sectional association between the presence of human herpesvirus 8 (HHV-8) serum antibodies and screen-detected prostate cancer in men living in Tobago. In the same study population, we examined the association between HHV-8 seropositivity and incident prostate cancer discovered at later screenings.
  
  
  METHODS
  In 40-81 year-old men without prostate cancer discovered at initial digital rectal examination (DRE) and prostate-specific antigen (PSA) screening, a case-cohort design measured the association between baseline HHV-8 seropositivity (modified immunofluorescence assay for antibodies against HHV-8 lytic antigens) and incident prostate cancer detected at DRE and PSA screenings three or five years later.
  
  
  RESULTS
  Analyses included 486 unique individuals, 96 incident prostate cancer cases, and 415 randomly selected subjects representing an at-risk cohort. By design, the random sub-cohort contained 25 incident prostate cancer cases. In the sub-cohort, the frequency of HHV-8 seropositivity increased across age groupings (40-49 years: 3.5%, 50-59 years: 13.6%, and ≥ 60 years: 22.9%). HHV-8 seropositivity was higher in men with elevated (≥ 4.0 ng/mL) than men with non-elevated PSA at initial screening (30.4% vs. 9.9% seropositive; crude odds ratio (OR) 3.96, 95% confidence interval (CI) 1.53-10.2; age-adjusted OR 2.42, 95% CI 0.91-6.47). HHV-8 seropositivity did not increase incident prostate cancer risk (age-adjusted hazard ratio (HR) 0.88, 95% CI 0.46-1.69).
  
  
  CONCLUSIONS
  Case-cohort analysis did not identify association between HHV-8 seropositivity and incident prostate cancer. However, analyses uncovered possible association between HHV-8 and PSA (a marker of prostate inflammation). Co-occurrence of HHV-8 seropositivity and PSA elevation may explain cross-sectional association between HHV-8 and PSA screen-detected prostate cancer.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, A542 Crabtree Hall, 130 DeSoto Street, Pittsburgh, Pennsylvania, 15261, USA. jwepid@pitt.edu.
authors.forename: Alicia C
authors.initials: AC
authors.lastname: McDonald
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Jenkins
authors.forename: Clareann H
authors.initials: CH
authors.lastname: Bunker
authors.forename: John W
authors.initials: JW
authors.lastname: Wilson
authors.forename: Alan L
authors.initials: AL
authors.lastname: Patrick
authors.forename: Joel L
authors.initials: JL
authors.lastname: Weissfeld