Abstract
PURPOSE: We evaluated the impact of benign prostatic hyperplasia (BPH) and prostatitis on the risk of prostate cancer (PCa) in patients using nationally representative data of the Korean population from the National Health Insurance Service. MATERIALS AND METHODS: A total of 5,580,495 Korean men, aged >20 years, who had undergone health screening in 2009 were followed-up for 9 years until 2017. Multivariate adjusted Cox regression analysis was conducted to determine the hazard ratio (HR) and 95% confidence interval (CI) for the association between BPH and/or prostatitis and PCa. The HR for PCa according to the presence of BPH and/or prostatitis was stratified by a combination of BPH and prostatitis in multivariable-adjusted models. RESULTS: The HR for PCa significantly increased in patients with BPH and prostatitis than in patients without BPH and prostatitis (adjusted HR, 1.626; 95% CI, 1.567-1.688 and adjusted HR, 1.557; 95% CI, 1.500-1.618, respectively). In particular, for the combination of BPH and prostatitis, the adjusted HR was 1.856 (95% CI, 1.743-1.976), which was the highest when a diagnosis of both BPH and prostatitis was made. CONCLUSIONS: BPH and/or prostatitis are associated with an increased incidence for PCa in Korean patients, which is likely associated with similar effects to prostate-specific antigen (PSA) screening, so care must be taken in the interpretation. However, if follow-up survival studies demonstrate differences between the two groups (BPH and prostatitis vs. general), it could be one of the evidence for the introduction of PSA screening in Korea.