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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 10  |  Page : 571-575

Asthma and the risk of prostate cancer


1 Department of General Surgery, Lianyungang Clinical Medical College of Nanjing Medical University, Lianyungang 222002, Jiangsu; Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu; Department of General Surgery, The First People's Hospital of Lianyungang, Lianyungang 222002, Jiangsu, People's Republic of China
2 Department of Pediatrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200023, People's Republic of China
3 Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
4 Department of General Surgery, Lianyungang Clinical Medical College of Nanjing Medical University; Department of General Surgery, The First People's Hospital of Lianyungang, Lianyungang 222002, Jiangsu, People's Republic of China

Date of Web Publication24-Sep-2018

Correspondence Address:
Dr. Yi Miao
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu
People's Republic of China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.176422

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 > Abstract 


Objective: The association between asthma and the risk of prostate cancer remains elusive. We aimed to evaluate the relationship between asthma and the onset of prostate cancer.
Methods: We searched PubMed, Embase, and Cochrane databases for articles that assessed the association of asthma with the risk of prostate cancer through October 2015. We extracted odds ratio (OR) and calculated the corresponding 95% confidence interval (CI). We used random-effects models to calculate a pooled association between asthma and the risk of prostate cancer.
Results: Fourteen studies were involved in the assessment of the association between asthma and prostate cancer risk. Asthma was not associated with the risk of prostate cancer in overall populations (OR 0.994, 95% CI 0.836–1.182), Caucasians (OR 0.922, 95% CI 0.825–1.030), and Asians (OR 5.022, 95% CI 0.415–60.793). The cumulative analysis also suggested a lack association between asthma and the risk of prostate cancer. Exclusion of any single study did not change the results significantly. No evidence of marked publication bias was observed.
Conclusions: Our investigation indicated that asthma was not associated with prostate cancer risk in overall populations, Caucasians, and Asians.

Keywords: Asthma, meta-analysis, prostate cancer, risk


How to cite this article:
Li W, Mao S, Tu M, Ge X, Li K, Xie F, Song Y, Miao Y. Asthma and the risk of prostate cancer. J Can Res Ther 2018;14:571-5

How to cite this URL:
Li W, Mao S, Tu M, Ge X, Li K, Xie F, Song Y, Miao Y. Asthma and the risk of prostate cancer. J Can Res Ther [serial online] 2018 [cited 2018 Dec 11];14:571-5. Available from: http://www.cancerjournal.net/text.asp?2018/14/10/571/176422

Wei Li, Song Mao and Min Tu contributed equally to this work.





 > Introduction Top


Prostate cancer is common cancer across the world.[1] Its incidence increased a lot during the past decades; some patients suffer from the bone metastasis of prostate cancer.[2] It causes a public concern. The risk factors for prostate cancer include family history, androgen, diet, and environmental factors.[3] There remain many prostate cancer cases unexplained. Inflammation was thought to might affect prostate tumorigenesis.[4] The inflammation pathways were associated with the risk of prostate cancer.

Asthma, a common disease, is a chronic inflammatory disease of the lungs.[5] Asthma is also closely associated with altered immune system dynamics and inflammatory response.[6] The hyperactive immune conditions might trigger chronic cellular inflammation, leading to the development of cancer. On the other hand, the medications of asthma, such as steroids, is also associated with the risk of prostate cancer.[7] Asthma is one of the most common allergic diseases, which may be associated with the carcinogenesis. Hence, to elucidate the relationship between asthma and prostate cancer risk seems imperative.

Currently, a number of studies have been conducted to investigate the association between asthma and prostate cancer risk.[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] However, the results were inconsistent across these studies. An improved understanding of this issue may have important clinical implications given the possibility that early monitoring and intervention may lower the risk of prostate cancer. Meta-analysis is a good way to summarize the available evidence to provide a robust result. A previous meta-analysis[22] reported the association between prostate cancer susceptibility and asthma. However, only eight studies were involved, the impact of ethnicity was not discussed.

With the accumulating evidence, we, therefore, performed this updated meta-analysis to evaluate the association between asthma and prostate cancer risk. We also investigate the influence of ethnicity and perform a cumulative analysis on the association of asthma and prostate cancer risk with the aim of providing a much more robust finding on the significance of this association.


 > Methods Top


Search strategy

We searched the publications regarding the association between asthma and the risk of prostate cancer through October 2015 by using PubMed, Embase, and Cochrane databases. No restriction was imposed on search language. The used search terms were as follows: (1) Prostate cancer, cancer, prostate, PC; and (2) asthma, chronic asthma, chronic. We searched the related publications by combining these terms. We also reviewed the reference lists of extracted reviews and articles.

Inclusion and exclusion criteria

Inclusion criteria

(1) Prospective, retrospective or case–control study; and (2) the outcome of interest was prostate cancer; and (3) a minimum of two comparison groups (asthma group versus control group); and (4) odds ratio (OR) with 95% confidence intervals (95% CIs) available (data to calculate them).

Exclusion criteria

(1) Case reports, editorials and reviews; (2) association between asthma and other cancers risk; and (3) multiple publications of the same data.

Data extraction and synthesis

We extracted study characteristics from each study. Data were recorded as follows:First author's surname, year of publication, ethnicity, study design, the number of asthma, and controls or OR/95% CI (lack of number of cases and controls). Two authors independently performed the data extraction with any disagreements resolved by discussion.

Statistical analysis

OR was used to measure the association between asthma and prostate cancer risk across studies. Heterogeneity of ORs among studies was tested by using the Q statistic (significance level at P < 0.05). The I2 statistic, a quantitative measure of inconsistency across studies, was also calculated. The combined ORs were calculated using a random-effects model. In addition, 95% CIs were also calculated. Subgroup analysis was conducted according to the ethnicity. Sensitivity analysis was performed by omitting any single study. Potential publication bias was assessed by Egger's test and Begg rank correlation test at the P < 0.05 level of significance. All analyses were performed using STATA version 12.0 (Stata Corporation, College Station, TX, USA). P < 0.05 was considered statistically significant, except where otherwise specified.


 > Results Top


Literature search

We initially extracted 357 relevant publications from the PubMed, Embase, and Cochrane databases. Of these, 343 studies were excluded according to the inclusion and exclusion criteria, 14 articles[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] were included in our study [Figure 1]. The extracted data were recorded as follows:First author's surname, publication year, study design, ethnicity, the number of asthma, and controls or OR/95%CI (lack of number of cases and controls).
Figure 1: Flow chart of study selection

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Characteristics for enrolled studies

Fourteen studies were identified for the analysis of the ORs of prostate cancer after asthma [Table 1]. These studies were published between 1985 and 2015. Six studies were prospective design, seven case–controls, one retrospective. Twelve studies were conducted in Caucasians and two in Asians.
Table 1: Characteristics of studies evaluating the association of asthma with prostate cancer risk

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Association of asthma with prostate cancer risk

Asthma was not associated with the risk of prostate cancer in overall populations (OR 0.994, 95% CI 0.836–1.182, P = 0.947), Caucasians (OR 0.922, 95% CI 0.825–1.030, P = 0.152), and Asians (OR 5.022, 95% CI 0.415–60.793, P = 0.205) [Figure 2]. The cumulative analysis also suggested a lack association between asthma and the risk of prostate cancer [Figure 3]. Marked heterogeneity was observed using Q and I2 statistic (P = 0.001, I2 = 68.6%) for overall populations. Exclusion of any single study did not change the results significantly.
Figure 2: Association between asthma and prostate cancer risk

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Figure 3: Cumulative analysis of the relationship between asthma and prostate cancer

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Publication bias

The funnel plot indicated no significant asymmetry [Figure 4]. The Begg rank correlation test and Egger linear regression test both indicated no marked publication bias across studies (Begg, P = 0.294; Egger, P = 0.103).
Figure 4: Publication bias for the analysis of association of asthma with prostate cancer risk

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 > Discussion Top


The incidence of asthma and prostate cancer increased a lot during the past years. The relationship between asthma and prostate cancer risk attracted the attention of both doctors and researchers. Our meta-analysis of pooled data from 14 studies shows that asthma is not associated with the risk of prostate cancer among overall populations, Caucasians, and Asians.

The null association between asthma and prostate cancer risk may be due to the following mechanisms:First, although chronic inflammation is thought to be involved in carcinogenesis, allergy might enhance the immune response, which may promote the immune system to recognize and remove cancer cells.[23] Allergies seem to be related with a lower risk of pancreatic cancer and non-Hodgkin lymphoma.[24] Second, although the medications of asthma, such as steroids, was associated with a higher cancer risk, the application of inhalation of glucocorticoid in asthma may lower the side effects of steroids. Finally, the application of antibiotics in asthma may attenuate the inflammation, which may be helpful for the prevention of prostate cancer. Our findings for the association between asthma and the risk of prostate cancer were consistent with the above-mentioned evidence. It indicated that asthma was not associated with the susceptibility of prostate cancer. The cumulative analysis also provided a more null association with the time relapse. The results also suggested that the medications of asthma may attenuate the complications.

In the past, a number of studies were performed to investigate the association between asthma and various cancers. Jacobs et al.[25] reported that having both hay fever and asthma was associated with modestly lower colorectal cancer mortality. Rosenberger et al.[26] reported that asthma may not have a causal effect on the risk of lung cancer. Olson et al.[27] reported that asthma was not associated with the risk of pancreatic cancer. Chen et al.[28] reported that allergic conditions may significantly reduce the risk of glioma. Gandini et al.[29] reported that allergies seem to be associated with a decreased risk of pancreatic cancer. These evidence was consistent with our findings. The hyperimmune response of asthma may be helpful for lowering the risk of carcinogenesis.

Although our study has obvious strengths, such as that, we investigated the influence of ethnicity and time on the risk of prostate cancer after asthma. Several limitations should be considered in our meta-analysis. First, heterogeneities might affect the results of our meta-analysis, although a random-effects model had been performed. Meanwhile, no marked publication bias was noted. Second, studies from other ethnicities, such as Africans, should be performed and enrolled in the future. Second, the severity and medications of asthma may affect the risk of prostate cancer. More data should be collected in the future to conduct a subgroup analysis to evaluate the influence of these factors. Finally, although 14 studies were enrolled in our meta-analysis, more participants should be included in our investigation.

According to our findings, further studies should be performed to address the following issues: (1) Clarification of the possible mechanisms behind the relationship between asthma and prostate cancer, (2) subgroup analysis in terms of medications and disease severity, (3) larger number, long-term, and prospective investigation of the risk of prostate cancer after asthma.


 > Conclusions Top


This meta-analysis indicates that asthma was not associated with the risk of prostate cancer in overall populations, Caucasians, and Asians. However, more studies should be conducted in the future to validate our findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
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