title: BPH: a tell-tale sign of prostate cancer? Results from the Prostate Cancer and Environment Study (PROtEuS).
abstract: BACKGROUND
  In a population-based case-control study (PROtEuS), we examined the association between prostate cancer (PCa) and (1) benign prostatic hypertrophy (BPH) history at any time prior to PCa diagnosis, (2) BPH-history reported at least 1 year prior to interview/diagnosis (index date) and (3) exposure to BPH-medications.
  
  
  METHODS
  Cases were 1933 men with incident prostate cancer diagnosed across Montreal French hospitals between 2005 and 2009. Population controls were 1994 men from the same age distribution and residential area. In-person interviews collected socio-demographic characteristics and medical history, e.g., BPH diagnosis, duration and treatment, as well as on PCa screening. Logistic regression analyses tested overall and grade-specific associations, including subgroup analyses with frequent PSA testing.
  
  
  RESULTS
  A BPH-history was associated with an increased risk of PCa (OR 1.37 [95 % CI 1.16-2.61]), more pronounced for low-grade PCa (Gleason ≤6: OR 1.54 [1.26-1.87]; Gleason ≥7: OR 1.05 [0.86-1.27]). The association was not significant when BPH-history diagnosis was more than 1 year prior to index date, except for low-grade PCa (OR 1.29 [1.05-1.60]). Exposure to 5α reductase inhibitors (5α-RI) resulted in a decreased risk of overall PCa (OR 0.62 [0.42-0.92]), particularly for intermediate- to high-grade PCa (Gleason ≤6: OR 0.70 [0.43-1.14]; Gleason ≥7: OR 0.43 [0.26-0.72]). Adjusting for PSA testing frequency or restricting analyses to frequently screened subjects did not affect these results.
  
  
  CONCLUSIONS
  BPH-history was associated with an increased PCa risk, which disappeared, when BPH-history did not include BPH diagnosis within the previous year. Our results also suggest that 5α-RI exposure exerts a protective effect on intermediate and high-grade PCa.
authors.affiliation: Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. boehm@martini-klinik.de.|Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada. boehm@martini-klinik.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Valdivieso
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.
authors.forename: José
authors.initials: J
authors.lastname: Sosa
authors.affiliation: INRS-Institut Armand-Frappier, Institut national de la recherche scientifique, Université du Québec, Laval, QC, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Blanc-Lapierre
authors.affiliation: INRS-Institut Armand-Frappier, Institut national de la recherche scientifique, Université du Québec, Laval, QC, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Weiss
authors.affiliation: Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: INRS-Institut Armand-Frappier, Institut national de la recherche scientifique, Université du Québec, Laval, QC, Canada.|Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
authors.forename: Marie-Élise
authors.initials: MÉ
authors.lastname: Parent
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 264 Blvd. Rene-Levesque E. Room 228, Montreal, QC, H2X 1P1, Canada.|Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000368:Aged; D002170:Canada; D016022:Case-Control Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D058891:5-alpha Reductase Inhibitors; D017430:Prostate-Specific Antigen
keywords: Benign prostatic hypertrophy; Case–control study; Diagnosis; Prostate biopsy; Prostate cancer
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