Inflammatory Bowel Disease and the Risk of Prostate Cancer

Some experts call for increased screening in males with IBD

A man sitting with his doctor, hands together, while the physician makes notes or points out information on a tablet.
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Inflammatory bowel disease (IBD, Crohn’s disease, ulcerative colitis, or indeterminate colitis) may put people at a higher risk of developing certain other diseases and conditions. This may include several types of cancer, including colon cancer, skin cancer, prostate cancer, and cervical cancer.

Prostate cancer is a common form of cancer that may affect people assigned male at birth. However, many men will never experience any symptoms from prostate cancer and only discover it after being screened.

The rate of prostate cancer in the United States is 11% and the risk of death is 2.5%, although this may be increased for those of African-American ancestry and those who have a family history of prostate cancer. The risk of prostate cancer may be increased in men with IBD, but there are no official screening recommendations in place.

The Prostate

The prostate is an important gland in the male reproductive system. When healthy and in men younger than the age of 50, it is usually about the size of a walnut and weighs about 0.75 ounces.

The prostate is located in the abdomen, in front of the rectum and between the penis and the urinary bladder. The urethra, which is the tube that carries sperm from the testes and urine from the bladder and out through the penis, also goes through the prostate. 

The prostate has a role in male fertility. It makes and secretes prostate fluid, which is one part of semen.

During ejaculation, sperm moves from the testes and into a series of tubes called the vas deferens. This causes the muscles in the prostate to contract around the urethra. This causes the urethra to be blocked from any urine coming through it. The semen can then enter the urethra and the prostate fluid is also released, mixing with the semen that came from the testes.

Prostate fluid contains an enzyme that’s called prostate-specific antigen (PSA). PSA helps make semen thinner.

Prostate fluid contains enzymes, citric acid, and zinc. It winds up becoming about a third of the contents of semen. Prostate fluid is one of the parts of semen that helps protect sperm. In particular, the seminal fluid is chemically basic. This helps the sperm to live longer in the vagina, which contains fluids that are chemically acidic. 

There are several conditions that can affect the prostate, including acute bacterial prostatitis, benign prostatic hyperplasia (BPH), chronic bacterial prostatitis, chronic prostatitis, and prostate cancer.

BPH is a condition that occurs when the prostate enlarges. This tends to happen as a man grows older. The reason why this is important is because a larger prostate can start to irritate the bladder or to partially close off the urethra. That may make urination more difficult. 

Prostate-Specific Antigen

Prostate-specific antigen (PSA) is one of the enzymes that is contained in the prostate fluid. A PSA test measures the level of this enzyme in the blood. The PSA level is measured as one part of checking the health of the prostate and for prostate cancer. PSA may be higher in men who have a variety of conditions of the prostate and who have prostate cancer. 

Prostatitis, which is inflammation of the prostate, is one condition that can cause an increase in the PSA level. BPH can also cause an elevated PSA level. Both of these conditions are not cancerous. Increased PSA levels might also be an indication of prostate cancer, but this is not always the case.

PSA levels used to be recommended yearly for all men over the age of 50, or earlier if there was a family history of prostate cancer, but these recommendations have changed over the years. For men who don’t have any symptoms of problems with the prostate, the PSA test might not be used. 

The PSA test has some drawbacks. There is no “normal” or “abnormal” PSA level, which means that the results might not have any bearing on the presence of disease or there could be false positives. Further, much of the PSA level testing was done on white men, which creates challenges in applying the results to minority groups.

In some cases, what may be more important is following the PSA level over time. If it is rising, that could be an indication that there is reason for further testing.

Prostate Cancer

Prostate cancer is a common form of cancer in men. Some of the risk factors for developing prostate cancer include:

  • Being over 50 years of age
  • Being of African-American, Hispanic, or of Native-American descent
  • Eating a diet that is higher in fat
  • Having a family member (brother or father) who had prostate cancer
  • Having certain genes that may increase the risk
  • A diagnosis of Lynch syndrome, which can increase the risk of some cancers

Screening for prostate cancer can include a PSA level test along with a digital rectal exam and a urine test.

During a digital rectal exam, a physician inserts a gloved, lubricated finger into the rectum. This allows the doctor to feel the prostate (which is located in front of the rectum). The doctor will feel the prostate to see if there are any hard areas or lumps and if there is any pain when it is touched.

If the results of all these tests suggest that prostate cancer is a possibility, a biopsy might be taken. A specialist physician, a urologist, will take several small pieces of tissue from the prostate. The tissue will be examined in a lab to see if there are any cancer cells.

If prostate cancer is diagnosed, treatment can take a few different forms. In some cases, there might not be any specific treatment needed, but watchful waiting to see if anything changes. Other types of therapy include hormone therapy, chemotherapy, radiation therapy, and surgery to remove all or part of the prostate (called a prostatectomy).

Prostate Cancer Risk and IBD

IBD is an immune-mediated condition and if it is not well-controlled, causes inflammation. It is theorized that chronic inflammation could play a role in the development of prostate cancer.

Inflammation of the prostate is often found at the same time as prostate cancer. What’s not well understood is if conditions like IBD that cause inflammation in the body could also contribute to the risk of cancer, including prostate cancer.

One retrospective, matched-cohort study from the Northwestern University Feinberg School of Medicine in Chicago included 1,033 male patients with IBD. A retrospective study looks at previous health records to see what outcomes occurred over a long period of time (in this case, it was between the years of 1996 and 2017).

The patients with IBD were matched and compared to 9,306 male patients who did not have IBD. All the patients included in the study had undergone at least one PSA level test. 

The researchers found that after 10 years, 4.4% of patients who had IBD were diagnosed with prostate cancer. Of the men who did have IBD, 0.65% of them were diagnosed with prostate cancer during the same time period. It was also found that the PSA levels in men with IBD were higher than they were in men who did not have IBD. 

The authors of the study did not find any link between the medications that are used to treat IBD (namely, those that suppress the immune system) and an increased risk of prostate cancer. They note, however, that they did not take into account how long men diagnosed with prostate cancer were receiving IBD medications.

Another point the researchers describe is that men with IBD may see their doctors more often than men who do not have IBD. Further, men with IBD may be more willing to have an exam like a digital rectal exam than men who do not have IBD. For that reason, it could be that men with IBD are more often diagnosed with prostate cancer because they are tested for it more often.

Another study, which was a meta-analysis, was done on the link between prostate cancer and IBD. In a meta-analysis, the researchers find several studies about a particular topic and collate all the results. They then do a mathematical analysis to understand how all the results from the various studies come together to support their hypothesis.

There were nine studies that were included in this meta-analysis of the connection between prostate cancer and IBD. What the results showed was that, in particular, men with ulcerative colitis were at a “significantly" increased risk of developing prostate cancer. The same link was not found for men with Crohn’s disease.

Possible Genetic Link

IBD is known to have a genetic component. It does tend to run in families, although it is thought that there is also an environmental trigger, which is why some family members are diagnosed with IBD and others are not.

Having genes associated with IBD may mean that a person is more susceptible to developing the disease. The same is true for prostate cancer in that some types are associated with particular genes.

Some of the genes that are associated with IBD are also associated with prostate cancer. This is thought to be one possible reason why rates of prostate cancer are increased in men who live with iIBD.

Pelvic Pouch Surgery and the Prostate

For men who have had pelvic pouch surgery, (ileal pouch-anal anastomosis, IPAA, which is commonly called j-pouch surgery), it may be more difficult to find prostate problems. A digital rectal exam may not be as accurate in men who live with a j-pouch.

Taking a biopsy of the prostate, which is normally done by going through the rectum, can have more potential complications. Going through the j-pouch to get a prostate biopsy could lead to the development of an abscess or a fistula.

If a biopsy is needed, it may be done by going through the perineum, which is located between the anus and the bottom of the penis. For these reasons, the PSA test may be recommended to screen for prostate cancer in men who have undergone j-pouch surgery.

Screening for Prostate Cancer in Men With IBD

The U.S. Preventive Services Task Force makes recommendations for screening for different forms of cancer, including prostate cancer. What they recommend for men between the ages of 55 and 69 is an individualized approach to screening.

This means that men should make decisions about being screened for prostate cancer together with their physician. This is because there has not been a great benefit shown from screening with PSA levels for men who aren’t having any symptoms.

Further, there can also be some harm in screening. For instance, a false positive in a PSA test could lead to having a biopsy of the prostate. Taking a biopsy of the prostate is an invasive procedure that comes with a certain amount of risk and discomfort. For men over the age of 70, screening with a PSA level test is not recommended.

The authors of some of the studies that show an increased risk of prostate cancer in men with IBD call for more screening. In one study, the researchers say that current screening levels might not be enough, and that “more thorough surveillance” should be done. The screening tests that are named include a PSA level test and a digital rectal exam.

However, with the screening recommendations being left up to patients and their doctors, there are no official guidelines for men with IBD. Men with IBD should consult with their gastroenterologist, their family physician or internist, and/or a urologist about prostate cancer screening. 

The decision to screen may be different for men who are experiencing symptoms. Symptoms could make screening more of a priority. Signs and symptoms of prostate cancer can be similar to those of other, non-cancerous conditions of the prostate.

In addition, because the prostate is located next to the rectum, men with IBD may not know if a symptom they are experiencing is from the bowel or the prostate. For men who have symptoms of prostate cancer, these can include: 

  • Blood in semen or urine
  • Difficulty in urination
  • Difficulty in getting or maintaining an erection
  • Frequent urination, especially at night
  • Painful urination
  • Pain during ejaculation
  • Pain while sitting

A Word From Verywell

The risk of prostate cancer may be increased in men who live with IBD and especially those diagnosed with ulcerative colitis. Screening for prostate cancer may be recommended but it’s largely a decision that’s made on an individual basis. Men with IBD should ask their gastroenterologist or primary care provider about their risk of prostate cancer and if screening should be done.

How often screening should take place is also an open question because yearly PSA level tests are no longer recommended. Having symptoms of a problem in the prostate may be an important part of knowing when to screen, so they should be brought up to a doctor if they occur.  

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Article Sources
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