Login to Access Video or Poster Abstract: MP17-02
Sources of Funding: NIDDK

Introduction

Advanced benign prostatic hyperplasia (BPH) exhibits a profile of gene expression similar to that seen in autoimmune inflammatory (AI) conditions such as rheumatoid arthritis (RA). Here we tested first, whether diagnoses of BPH and an AI condition are at an increased likelihood of occurring in the same patient and second, whether patients treated for an AI condition had an altered incidence of subsequent BPH. Subsequent analysis focused on the effects of specific therapies.

Methods

We extracted deidentified patient data from an electronic data warehouse covering men over the age of 40 presenting at NorthShore clinics over a period of three years (1/1/09-12/31/11). The cohort included 101,383 men with no history of AI and 10,769 men with a diagnosis of one or more AI conditions. These groups were subdivided into men with and without a diagnosis of BPH, type of AI condition, and whether the AI condition occurred before or after the diagnosis of BPH. Rates were compared between groups using chi-square test. The effects of specific AI therapies on BPH were examined.

Results

In the control group 20,586 (20.3%) were diagnosed with BPH. Of the men with an AI diagnosis, 3,294 (30.6%) were also diagnosed with BPH, demonstrating a significant positive association (p<0.01). However when men were treated for an AI condition their chance of a subsequent BPH diagnosis dropped significantly, and overall was slightly, but significantly, lower than the control baseline at 19.4% (p<0.01). Some conditions (notably, RA, Crohns disease and ulcerative colitis) are associated with significantly higher rates of BPH while others (e.g. Celiac disease and Multiple sclerosis) show no significant difference. Treatments for some conditions e.g., psoriasis and RA resulted in large drops in subsequent BPH diagnosis. Analysis of the treatments provided to the AI patients revealed that most of the effect of BPH reduction was associated with the use of TNFα-antagonist therapies with minor contributions from other treatments such as low dose methotrexate use.

Conclusions

This study reveals clear associations between BPH and AI diagnoses and is strongly suggestive that some medical approaches applied to AI disorders may affect the pathogenesis and progression of BPH. Differences in the coincidence and treatment effects of therapies for various conditions may reflect the individual disease and drug characteristics and bears further examination. These data elucidate new pathways that can be examined to determine whether they can be applied to BPH.

Funding

NIDDK