CHINA: Study on Cholelithiasis and Prostate Cancer Risk

A recent study published in BMC Urology evidenced the positive association between Cholelithiasis and increased risk of prostate cancer.

Risk factors promoting gallstone formation include genetics, environmental factors, diabetes, and metabolic syndrome. High cholesterol accumulates in the cancer tissues and is associated with the risk of prostate cancer. Cancer cells rely on cholesterol, which satisfies the increased nutrient demands, and in this manner, their uncontrolled growth is supported, thereby favoring tumor development and progression. Evidence suggests a lower possibility of progressive prostate carcinoma (PCa) in men on statin therapy after prostatectomy.

Prostate carcinoma cases are detected annually by more than 1,275,000, being the second most common malignancy and the leading cause of mortality among men. The risk factors include ethnicity, germline mutation, and dietetic factors. It has a prevalence rate of 5 to 15% (in the western population) and is a significant public health problem.

According to epidemiologic studies, Cholelithiasis has been associated with the risk of prostate cancer in terms of development and progression. Still, the results and the relationship between the two studies remain controversial.

To assess more on the unknown research topic, a hospital-based study was conducted by Dr. Ya-Dong Li from the Department of Urology at The Second Affiliated Hospital of the Chongqing Medical University, with a team of researchers to analyze the relationship between Cholelithiasis and risk of prostate cancer. A systematic meta-analysis of published studies and our case-control analysis was performed to evaluate this controversial association.

A subgroup analysis was performed based on the study regions, BMI level, gallstones, and cholecystectomy.

The critical points of the study are:

• The medical records of the Second Affiliated Hospital of Chongqing Medical University Hospital were reviewed for the study.
• A total of 7 studies involving 80,403 individuals were included in the meta-analysis.
• There were 221 cases of newly diagnosed PCa with an average age of 72.29 ± 8.02 years and 219 controls of age 71.14 ± 7.68 years recruited in the study.
• Cases were likelier to have a history of diabetes and cholelithiasis with a P value of < 0.05 than controls.
• Cholelithiasis was significantly associated with a higher risk of PCa with an Odds ratio (OR) of 1.98. The adjusted OR was 1.87 after multivariable adjustment for confounding factors.
• OR was 2.53 for the association of gallstones with PCa, which was significant.
• Cholelithiasis was associated with an increased risk of PCa with a Relative Ratio (RR) of 1.35 and the evidence was moderate-quality.
• The RR was 1.54 and 95% confidence interval for men with Cholelithiasis having lower BMI and were at a higher risk of PCa.
• Cholecystectomy was not related to the incidence of PCa and was increased in patients with gallstones.
• Subgroup analysis showed that Cholelithiasis was associated with PCa in Europe and Asia with RR of 1.24 and 1.32.

The researcher wrote, "We suggest an association between Cholelithiasis and the risk of PCa, and there is no significant relationship between cholecystectomy therapy and PCa risk. Further studies should be conducted to add depth to the research."

Our study had strengths related to comprehensive estimation between the association and use of the GRADE approach, thereby ensuring the quality of the evidence.

Reference:

Li YD, Ren ZJ, Gao L, Ma JH, Gou YQ, Tan W, Liu C. Cholelithiasis increased prostate cancer risk: evidence from a case-control study and a meta-analysis. BMC Urol. 2022 Oct 3;22(1):160. DOI: 10.1186/s12894-022-01110-8.