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Proffered Abstract (Oral Presentation): Prostate: Risk and Prevention

Prediagnostic interleukin-6, C-reactive protein and prostate cancer incidence and mortality.

Harvard School of Public Health, Boston, MA; Harvard Medical School, Boston, MA

Abstract

PR-11

Background: The pleiotropic cytokine interleukin-6 (IL-6) is induced in response to viral infection, lipopolysaccharide exposure, and other cytokines. Circulating IL-6 is secreted primarily from adipose tissue. IL-6 has promoting carcinogenic properties including inducing cell proliferation, altering secretion of enzymes involved in tumor invasion, reducing apoptosis, and stimulation of acute immune response reactants, including C-reactive protein (CRP). Among prostate cancer patients, IL-6 and CRP levels are associated with poor prognosis. Methods: We aimed to determine if pre-diagnostic plasma levels of IL-6 and CRP were associated with prostate cancer incidence or mortality in a prospective study nested within the Physicians' Health Study that included 516 cases and 516 controls matched on age and smoking status. The median time between blood draw and prostate cancer diagnosis was 9.4 years. Conditional logistic regression models were employed to estimate the relative risk of prostate cancer incidence according to biomarker levels, while Cox models among cases were used to examine biomarker levels as predictors of survival, adjusted for covariates. Results: Overall, plasma IL-6 levels were not associated with prostate cancer risk. However, BMI modified the association between IL-6 and prostate cancer (p for interaction = 0.04) with increasing risks among healthy weight men (BMI <25) (RR=1.4 comparing highest to lowest quartiles, p for trend = 0.04). IL-6 was not associated with risk among overweight men (BMI > 25). Plasma CRP levels were associated with higher risk of incident prostate cancer (RR = 1.4 comparing highest to the lowest quartiles, p for trend =0.05) particularly for lethal disease (RR=2.3, p for trend =0.03). In line with IL-6 data, the CRP and prostate cancer association appeared stronger among healthy weight men, with the RRs (95% CI) for CRP compared to lowest quartile (Q1) of 1.0 (Q2) 1.3 (Q3), 1.8 (1.1, 2.8) (Q4), p for trend = 0.01. No association with CRP was evident for overweight men. Pre-diagnostic IL-6 and CRP levels were not associated with risk of prostate cancer death in a survival analysis among the 516 cases overall. However, high IL-6 was associated with a two-fold increased risk of developing lethal cancer among healthy weight cases. Conclusion: IL-6 and CRP are markers of inflammatory processes that produce a cellular environment more conducive to oncogenesis and cancer progression. Because IL-6 is secreted from adipose and IL-6 stimulates synthesis of CRP, both markers may be more indicative of inflammation in men of a healthy weight. In this study, increased levels of IL-6 or CRP many years prior to diagnosis appear to be predictors of future prostate cancer risk in men with healthy weight, and pre-diagnostic levels of IL-6 men of a healthy weight also are associated with a less favorable prognosis.