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Sandy Srinivas, MD


Treatment Choice, Immunity, Urinary Tract Infection: All Factors in Prostate Cancer Survival?

By: Celeste L. Dixon
Posted: Thursday, August 10, 2023

Trends in urinary tract infections may be somehow connected to the prognosis of patients with prostate cancer who have had open or laparoscopic radical prostatectomy, robot-assisted radical prostatectomy, or radiation therapy as definitive treatment. Specifically, greater severity of urinary tract infections might be related to poorer prognosis, wrote Se Young Choi, MD, PhD, of Chung-Ang University, Seoul, Korea, and colleagues in BMC Cancer. Their study involved the analysis of data of 28,887 patients diagnosed between 2007 and 2016 and treated definitively.

In the acute phase (< 3 months after treatment), urinary tract infections were more frequent after radical prostatectomy than after radiation therapy. However, in the chronic phase (> 12 months), urinary tract infections were more frequent after radiation therapy than after radical prostatectomy.

In the early follow-up period, urinary tract infection risk was higher in the open or laparoscopic radical prostatectomy group (P < .001) and the robot-assisted radical prostatectomy group (P < .001) compared with the radiation therapy group. The robot-assisted radical prostatectomy group had a lower risk of urinary tract infections than the open or laparoscopic radical prostatectomy group in the early (P < .001) and late (P < .001) follow-up periods.

Finally, in patients with urinary tract infection, Charlson Comorbidity Index score, primary treatment, age at diagnosis of urinary tract infection, type of urinary tract infection, hospitalization, and sepsis from urinary tract infection were risk factors for overall survival. The immune system, the investigators noted, is an important defense mechanism against cancer cells as well as exogenous agents that cause infection.

Dr. Choi and co-investigators made several points regarding the potential involvement of immunity: Primary radiation therapy could trigger immune changes by suppressing anticancer immunity; androgen-deprivation therapy could remodel the tumor immune microenvironment; and “with changes in immunity during prostate cancer treatment, the severity of urinary tract infections (including upper urinary tract infections), hospitalization, or sepsis could indicate patients’ vulnerability to prostate cancer.”

Disclosure: The study authors reported no conflicts of interest.

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