Chronic Periodontal Disease increases risk for Prostate Cancer in Elderly individuals in South Korea: a Retrospective Nationwide Population-based Cohort Study
Do-hyung Kim, Seong-Nyum Jeong and Jae-Hong Lee
Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, Korea.
Corresponding author: Jae-Hong Lee, PhD, Department of Periodontology, Daejeon Dental Hospital, Wonkwang University College of Dentistry, 77, Dunsan-ro, Seo-gu, Daejeon 35233, Korea, E-mail: ljaehong@gmail.com, Tel.: +82-42-3661114, Fax: +82-42-3661115.
Objectives: The association between prostate cancer (PC) and chronic periodontal disease (PD) has been evaluated in previous studies, but results have been inconsistent. This study aimed to determine whether the presence of chronic PD in old age increases the risk of PC using data in the large-scale elderly cohort.
Materials and Methods: This nationwide population-based cohort study examined data of 121,240 South Korean individuals aged ≥ 60 years from the National Health Insurance Service–Elderly Cohort database who completed a national program between 2002 and 2015. For a maximum 10 years’ observation period, patients with incident PC with chronic PD compared with those without chronic PD were retrospectively tracked, and Cox proportional hazard ratios and 95% confidence intervals (CIs) were calculated, adjusted for potential confounding factors, including age, household income, insurance status, Charlson Comorbidity Index, hypertension, diabetes mellitus, cerebral infarction, angina pectoris, myocardial infarction, prostatitis, smoking status, daily smoking, alcohol intake habits, one-time alcohol intake, and regular exercise.
Results: The overall incidence of PC with chronic PD in 10 years was 3.0% (n = 2,063). In the multivariate Cox analysis with adjustment for confounding factors, chronic PD was associated with a 24% higher risk of PC (95% CI = 1.16–1.32, P < 0.001).
Conclusion: Our results suggest that chronic PD is significantly and positively associated with PC. Larger and better-controlled studies are needed to strengthen this evidence of association and explain the underlying biological mechanisms.
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Graham49
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It does make sense to me. Periodontal diease and Gingivitis means chronically infected gums....keeping chronic inflammation ongoing. And as we know, chronic inflammation not only initiates but also propagates prostate cancer.
When my dad was diagnosed I did my own research about that. I dont know why I had a suspicion about the link between periodontal disease and prostate cancer. I found some retrospective studies where they found high asociation with some cancers, specially gastro-related cancers, but a low asociation with prostate (still probable but not definitive).
Since our family dont have history of any kind of cancer, I focused on that. I now reinforce that idea. His periodontal disease is long dated and very important.
I read this and just called my dentist to tell I want to go there tomorrow, haha...just in case!
We need to keep our gum infection and inflammation under full control...by Chlorhexidine mouthwash, Listerine mouthwash, Hydrogen peroxide mouthwash or if needed antibiotics such as Minocycline or Doxycycline. Time for talk with a dentist !
As this extract from the discussion section of the paper indicates, the cause and effect have not been established. Genetics, inflammation, immune responses, bacteria, prostatitis may be linked to periodontal disease and PCa. Also men on ADT were more likely to have PD.
"Moreover, some genes (particularly CDKN2B) that are significantly and consistently related with cancer are also associated with PD, which suggests shared genetic susceptibility between the two diseases [28].
Activated inflammatory cells, including neutrophils, macrophages, and dendritic cells, secrete pro-inflammatory and pro-growth substances, such as tumor necrosis factor (TNF)-α, cytokines, chemokines, matrix metalloproteases, and pro-angiogenic molecules. These cells also produce reactive oxygen and nitrogen species, which can induce DNA damage in epithelial cells and produce an environment for both initiation and promotion of carcinogenesis at local and distant sites [32-34]. Periodontal pathogens might promote cancer development through invasion of blood vessels, bacteremia, and subclinical infection in distant sites [28].
Among the comorbidities investigated in this study, prostatitis was found to have the closest relationship with PC (crude HR 2.07, 95% CI 1.91– 2.25, P < 0.001; adjusted HR 1.92, 95% CI 1.77–2.08, P < 0.001). Patients with moderate-to-severe prostatitis and chronic PD were found to have higher prostate-specific antigen levels, which are used to track response to androgen deprivation therapy (ADT) for PC [35]. Famili et al. found that men with PC undergoing ADT were more likely to have PD than men not undergoing ADT [36]. Both PD and prostatitis result in cytokine imbalance toward increased pro-inflammatory cytokines, such as interleukine (IL)-6, IL-8, IL-18, TNF-α, and C-reactive protein, and decreased anti-inflammatory cytokines [37]. Additionally, major clinical parameters of PD, especially clinical attachment level, were significantly worse in patients with moderate-to-severe prostatitis [35,37]. Considering the similarity in the etiopathogenesis of prostatitis and PD, it is possible that there is a pathological link between them; however, further studies are necessary to draw a conclusion."
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