Men with inflammatory bowel disease have four to five times higher risk of being diagnosed with prostate cancer, according to a 20-year study from Northwestern Medicine published in the journal European Urology.
Shilajit Kundu, MD, chief of Urologic Oncology and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University discusses the link between prostate cancer and inflammatory bowel disease. He shares Northwestern Medicine's approach to screening, diagnosing and treating this unique combination of conditions.
Selected Podcast
The Link Between Prostate Cancer and Inflammatory Bowel Disease
Featured Speaker:
Dr. Kundu has published on prospective evaluations of patients with urologic cancers including prostate, bladder, kidney and testicular cancer and have found that the impact of cancer treatment goes beyond physical limitations associated with treatment. His research aims to understand the complexities associated with patient expectations. This includes balancing factors associated with patient satisfaction including patient personality, physician-patient relationship, i...[Read full text] I have successfully conducted and published on prospective evaluations of patients with urologic cancers including prostate, bladder, kidney and testicular cancer and have found that the impact of cancer treatment goes beyond physical limitations associated with treatment. My recent research aims to understand the complexities associated with patient expectations. This includes balancing factors associated with patient satisfaction including patient personality, physician-patient relationship, information-processing style, and a comforting experience with the health care environment.Dr. Kundu’s research focuses include treatment of bladder cancer, kidney cancer, urinary tract cancer, prostate cancer, robotic prostatectomy, robotic nephrectomy, and cancer genetics.
Dr. Kundu’s research focuses on strategies to diagnose and characterize bladder cancer, novel strategies to characterized prostate cancer aggressiveness, and prospectively studying quality of life outcomes in patients with urologic cancers. His clinical interests include bladder cancer, continent urinary diversions for bladder cancer, multimodal therapy for advanced cancers including surgical therapy for bladder cancer, prostate cancer, kidney cancer, testis cancer, robotic surgery for bladder cancer, and testis cancer treatment.
Shilajit D. Kundu, MD
Shilajit D Kundu, MD, Chief of Urologic Oncology, Department of Urology, Northwestern MedicineDr. Kundu has published on prospective evaluations of patients with urologic cancers including prostate, bladder, kidney and testicular cancer and have found that the impact of cancer treatment goes beyond physical limitations associated with treatment. His research aims to understand the complexities associated with patient expectations. This includes balancing factors associated with patient satisfaction including patient personality, physician-patient relationship, i...[Read full text] I have successfully conducted and published on prospective evaluations of patients with urologic cancers including prostate, bladder, kidney and testicular cancer and have found that the impact of cancer treatment goes beyond physical limitations associated with treatment. My recent research aims to understand the complexities associated with patient expectations. This includes balancing factors associated with patient satisfaction including patient personality, physician-patient relationship, information-processing style, and a comforting experience with the health care environment.Dr. Kundu’s research focuses include treatment of bladder cancer, kidney cancer, urinary tract cancer, prostate cancer, robotic prostatectomy, robotic nephrectomy, and cancer genetics.
Dr. Kundu’s research focuses on strategies to diagnose and characterize bladder cancer, novel strategies to characterized prostate cancer aggressiveness, and prospectively studying quality of life outcomes in patients with urologic cancers. His clinical interests include bladder cancer, continent urinary diversions for bladder cancer, multimodal therapy for advanced cancers including surgical therapy for bladder cancer, prostate cancer, kidney cancer, testis cancer, robotic surgery for bladder cancer, and testis cancer treatment.
Transcription:
Melanie Cole (Host): Welcome. Today we’re talking about the link between prostate cancer and inflammatory bowel disease and Northwestern Medicine’s approach to screening, diagnosing and treating this unique combination of conditions. My guest today is Dr. Shilajit Kundu. He’s the Chief of Urologic Oncology in the Department of Urology at Northwestern Medicine. Dr. Kundu, it’s a pleasure to have you with us and what an interesting topic we’re talking about today. Last year, Northwestern Medicine published a study linking inflammatory bowel disease and prostate cancer. Tell us a little bit about that study.
Shilajit D. Kundu, MD (Guest): Well thank you so much for having me. I think this is a very interesting topic that we came across or I came across a few years ago and the reason I wanted to study this was I had a few patients who had inflammatory bowel disease who saw me due to a condition of an elevated prostate specific antigen or PSA. And a lot of these patients have elevated PSAs and that can be caused due to a variety of different things including inflammation, or prostate cancer or benign enlargement of the prostate. And so I was seeing these patients and they were seeing me but we didn’t really know if their PSA elevation was related to some inflammation that was happening in the gut or the intestines or really what it an indicator of prostate cancer that we needed to find out about.
And I looked in the literature and really, there is nothing in the literature other than our study which was first published last year to outline how we should be treating men, or should we be concerned about men with an elevated PSA and whether there’s an increased risk for prostate cancer. So, the first thing we did, is we took a group of about 10,000 men, about 1,000 of them had inflammatory bowel disease and then we matched them to controls or men without inflammatory bowel disease by age, and race and we looked at their PSAs, the PSA values over time. And we had about a twenty year follow up or 20 year interval that we followed patients. And what we looked is that their PSAs and found that starting at about the age of 55, when most men are screened for prostate cancer through PSA testing; that the men with inflammatory bowel disease had a significantly higher PSA compared to the controls.
And as a man aged or when you specifically got into about 60, 65 and 70; at each year of life; the PSA value seemed to increase. So, we thought that that was an interesting finding, but I really had no idea at that particular time whether it was just the PSA or truly that was an increased risk for prostate cancer. So, what we did, is we delved into our patient information a little bit more specifically. And sure enough, what we found is that the men with inflammatory bowel disease had about a fivefold increased risk of being diagnosed with prostate cancer compared to the controls.
So, really, that was kind of a landmark groundbreaking finding that really had not been reported before at least in a more urologic base or kind of to the lay media or the people who needed to know. And we really thought that that was a reflection of not only is the PSA elevated, but it truly may mean that those men are at increased risk of having prostate cancer.
Host: Wow, that’s fascinating, Dr. Kundu. So, tell us a little bit amount Northwestern Medicine’s approach to screening as these patients may need to be screened more carefully than a man that does not have inflammatory bowel disease. How do you approach that?
Dr. Kundu: That’s a great question. And we don’t exactly know yet how to approach these men with inflammatory bowel disease and prostate cancer, how they should be screened. Because our data, our study is one of the first to report these findings in people who chose to have prostate cancer screening. However, so I can’t say at this current time whether men should be – the age at which inflammatory bowel disease patients should be screened earlier or not but I can say in men with inflammatory bowel disease who have an elevated PSA; I think one of the knee jerk reactions that many clinicians have including myself, including other very well respected urologists is they’ll say that this person just has inflammation of their gut which is leading to an elevated PSA.
But the reality is, we have no data to actually support whether that is happening, and we really have no idea how gut inflammation, if at all, is transmitted to the prostate. So, I think at the current time, that’s what we’re interested in studying and that’s what we are studying to try to truly piece out what the effect of this is in these patients. So, for example, is it some genetic commonality between the two? So, for example, prostate cancer is a disease state or is a cancer that is associated with some genetic predisposition and inflammatory bowel disease does have similar characteristics. And we’re trying to see if there are commonalities or common links between the two to try to see if certain men with inflammatory bowel disease may also harbor some genetic predisposition.
Another thing is, we’re trying to study whether it truly is an effect of inflammation in the increased risk of prostate cancer. So, for example, men who have inflammatory bowel disease, I should say men, all people including women with inflammatory bowel disease have an increased risk of certain intestinal related cancers such as colon cancers. However, if you calm that inflammation, you decrease that risk of colon cancer. So, the question is, in these patients who have chronic inflammatory bowel disease; is it different with each individual patient. So, someone who is having more significant disease, are they more at risk than someone who has a milder case.
I really think what it does show is that in people who elect prostate cancer screening who have inflammatory bowel disease; don’t just assume it’s from their inflammatory bowel disease. It may truly be that they have prostate cancer that could be delayed in diagnosis, could have a delay in diagnosis if you don’t treat it like a true PSA effect.
Host: I find that so interesting when you mentioned genetic markers and predisposition. So, if you determine that someone does have this as we said, unique combination; tell us a little bit about your approach to treating this and obviously, you are going to look at the cancer pretty seriously, but inflammatory bowel disease is also – can be a very serious life changing disease. So, please speak about how you can treat both of these.
Dr. Kundu: I think that’s a great question. I think the main thing with inflammatory bowel disease is getting the symptoms under control. So, the landscape of inflammatory bowel disease as well as prostate cancer is changing dramatically in the course of the medication that’s delivered to treat it. So, inflammatory bowel disease was treated with certain medications such as steroids, and other things but now there are a lot of immunomodulating agents that can quell or calm the disease state. So, historically, prostate cancer in men with inflammatory bowel disease is treated with surgery because, radiation is thought to be something that could aggravate inflammatory bowel disease.
So, in general, although this is not 100% the case, but we would generally steer these patients towards a more surgical approach if it’s appropriate. Now one thing that we have found is that not all prostate cancers are the same. So, there are some low risk prostate cancers that don’t necessarily need to be treated. They are monitored very carefully through a process called active surveillance where we monitor these cancers for becoming a little bit worse.
With inflammatory bowel disease, we found that there was a significantly increased risk of patients who may not be candidates for active surveillance and may need treatment. So, one of the questions within prostate cancer is whether you need to treat all prostate cancer. One of the important things of our study was that not only did all prostate cancer risk increase, what we would term as clinically significant prostate cancer or grade group two or Gleason 7 prostate cancer increased in the inflammatory bowel disease group.
So, I think it’s more of an education – it’s something that we need to get the news out that there may be a link between inflammatory bowel disease and prostate cancer and don’t just assume it’s gut inflammation. The mechanisms of how this is – why this is happening is what we are currently studying. This includes genetic markers and genetic testing that we are in the process of studying as we speak. We are also studying the effect of immunomodulating agents that are becoming more and more popular and more and more effective and whether these have an effect on the risk of prostate cancer, whether it’s increased or decreased, and we are also using mouse models and doing tissue based analyses to see what is the effect of the gut inflammation to the prostate. Is inflammation of the gut, whether it be in the small intestine or the large intestine, transmitted to the prostate and we don’t know the answer to that, but we are using mouse models to currently study it and what it does seem in an acute inflammatory bowel disease mouse model; that the inflammation of the gut is transmitted to the prostate.
The question is, why is that being translated to an increased risk for prostate cancer? And we are in the process of studying that as we speak.
Host: So, interesting. Dr. Kundu, as we wrap up, what would you like other providers to know about this correlation and when you feel it’s important that they refer to the specialists at Northwestern Medicine?
Dr. Kundu: I think this is a very interesting piece of information that I think primary care doctors need to know and GI doctors or gastroenterologists need to know because they may not be aware of the association. And I think if a man elects to have prostate cancer screening and they have an elevated PSA; it really should be an indicator that they need to be referred to a urologist for an evaluation because not all elevated PSA is related to gut inflammation. And I really think that the take home message is if a man chooses to have prostate cancer screening and he has inflammatory bowel disease; don’t assume that some abnormality on the prostate exam or abnormality on the PSA serum test is just a false result. Send them to the urologist so they can get appropriately screened, have an appropriate discussion, biopsy and treated if necessary.
Host: Wow, thank you so much and wish you luck in continuing research. What a fascinating topic. Thank you again for joining us. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine; head on over to our website at www.nm.org to get connected with one of our providers. If you found this podcast as educational and informative as I did; please share on social media, share with other providers. That way we are all learning about this exciting research together. And be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): Welcome. Today we’re talking about the link between prostate cancer and inflammatory bowel disease and Northwestern Medicine’s approach to screening, diagnosing and treating this unique combination of conditions. My guest today is Dr. Shilajit Kundu. He’s the Chief of Urologic Oncology in the Department of Urology at Northwestern Medicine. Dr. Kundu, it’s a pleasure to have you with us and what an interesting topic we’re talking about today. Last year, Northwestern Medicine published a study linking inflammatory bowel disease and prostate cancer. Tell us a little bit about that study.
Shilajit D. Kundu, MD (Guest): Well thank you so much for having me. I think this is a very interesting topic that we came across or I came across a few years ago and the reason I wanted to study this was I had a few patients who had inflammatory bowel disease who saw me due to a condition of an elevated prostate specific antigen or PSA. And a lot of these patients have elevated PSAs and that can be caused due to a variety of different things including inflammation, or prostate cancer or benign enlargement of the prostate. And so I was seeing these patients and they were seeing me but we didn’t really know if their PSA elevation was related to some inflammation that was happening in the gut or the intestines or really what it an indicator of prostate cancer that we needed to find out about.
And I looked in the literature and really, there is nothing in the literature other than our study which was first published last year to outline how we should be treating men, or should we be concerned about men with an elevated PSA and whether there’s an increased risk for prostate cancer. So, the first thing we did, is we took a group of about 10,000 men, about 1,000 of them had inflammatory bowel disease and then we matched them to controls or men without inflammatory bowel disease by age, and race and we looked at their PSAs, the PSA values over time. And we had about a twenty year follow up or 20 year interval that we followed patients. And what we looked is that their PSAs and found that starting at about the age of 55, when most men are screened for prostate cancer through PSA testing; that the men with inflammatory bowel disease had a significantly higher PSA compared to the controls.
And as a man aged or when you specifically got into about 60, 65 and 70; at each year of life; the PSA value seemed to increase. So, we thought that that was an interesting finding, but I really had no idea at that particular time whether it was just the PSA or truly that was an increased risk for prostate cancer. So, what we did, is we delved into our patient information a little bit more specifically. And sure enough, what we found is that the men with inflammatory bowel disease had about a fivefold increased risk of being diagnosed with prostate cancer compared to the controls.
So, really, that was kind of a landmark groundbreaking finding that really had not been reported before at least in a more urologic base or kind of to the lay media or the people who needed to know. And we really thought that that was a reflection of not only is the PSA elevated, but it truly may mean that those men are at increased risk of having prostate cancer.
Host: Wow, that’s fascinating, Dr. Kundu. So, tell us a little bit amount Northwestern Medicine’s approach to screening as these patients may need to be screened more carefully than a man that does not have inflammatory bowel disease. How do you approach that?
Dr. Kundu: That’s a great question. And we don’t exactly know yet how to approach these men with inflammatory bowel disease and prostate cancer, how they should be screened. Because our data, our study is one of the first to report these findings in people who chose to have prostate cancer screening. However, so I can’t say at this current time whether men should be – the age at which inflammatory bowel disease patients should be screened earlier or not but I can say in men with inflammatory bowel disease who have an elevated PSA; I think one of the knee jerk reactions that many clinicians have including myself, including other very well respected urologists is they’ll say that this person just has inflammation of their gut which is leading to an elevated PSA.
But the reality is, we have no data to actually support whether that is happening, and we really have no idea how gut inflammation, if at all, is transmitted to the prostate. So, I think at the current time, that’s what we’re interested in studying and that’s what we are studying to try to truly piece out what the effect of this is in these patients. So, for example, is it some genetic commonality between the two? So, for example, prostate cancer is a disease state or is a cancer that is associated with some genetic predisposition and inflammatory bowel disease does have similar characteristics. And we’re trying to see if there are commonalities or common links between the two to try to see if certain men with inflammatory bowel disease may also harbor some genetic predisposition.
Another thing is, we’re trying to study whether it truly is an effect of inflammation in the increased risk of prostate cancer. So, for example, men who have inflammatory bowel disease, I should say men, all people including women with inflammatory bowel disease have an increased risk of certain intestinal related cancers such as colon cancers. However, if you calm that inflammation, you decrease that risk of colon cancer. So, the question is, in these patients who have chronic inflammatory bowel disease; is it different with each individual patient. So, someone who is having more significant disease, are they more at risk than someone who has a milder case.
I really think what it does show is that in people who elect prostate cancer screening who have inflammatory bowel disease; don’t just assume it’s from their inflammatory bowel disease. It may truly be that they have prostate cancer that could be delayed in diagnosis, could have a delay in diagnosis if you don’t treat it like a true PSA effect.
Host: I find that so interesting when you mentioned genetic markers and predisposition. So, if you determine that someone does have this as we said, unique combination; tell us a little bit about your approach to treating this and obviously, you are going to look at the cancer pretty seriously, but inflammatory bowel disease is also – can be a very serious life changing disease. So, please speak about how you can treat both of these.
Dr. Kundu: I think that’s a great question. I think the main thing with inflammatory bowel disease is getting the symptoms under control. So, the landscape of inflammatory bowel disease as well as prostate cancer is changing dramatically in the course of the medication that’s delivered to treat it. So, inflammatory bowel disease was treated with certain medications such as steroids, and other things but now there are a lot of immunomodulating agents that can quell or calm the disease state. So, historically, prostate cancer in men with inflammatory bowel disease is treated with surgery because, radiation is thought to be something that could aggravate inflammatory bowel disease.
So, in general, although this is not 100% the case, but we would generally steer these patients towards a more surgical approach if it’s appropriate. Now one thing that we have found is that not all prostate cancers are the same. So, there are some low risk prostate cancers that don’t necessarily need to be treated. They are monitored very carefully through a process called active surveillance where we monitor these cancers for becoming a little bit worse.
With inflammatory bowel disease, we found that there was a significantly increased risk of patients who may not be candidates for active surveillance and may need treatment. So, one of the questions within prostate cancer is whether you need to treat all prostate cancer. One of the important things of our study was that not only did all prostate cancer risk increase, what we would term as clinically significant prostate cancer or grade group two or Gleason 7 prostate cancer increased in the inflammatory bowel disease group.
So, I think it’s more of an education – it’s something that we need to get the news out that there may be a link between inflammatory bowel disease and prostate cancer and don’t just assume it’s gut inflammation. The mechanisms of how this is – why this is happening is what we are currently studying. This includes genetic markers and genetic testing that we are in the process of studying as we speak. We are also studying the effect of immunomodulating agents that are becoming more and more popular and more and more effective and whether these have an effect on the risk of prostate cancer, whether it’s increased or decreased, and we are also using mouse models and doing tissue based analyses to see what is the effect of the gut inflammation to the prostate. Is inflammation of the gut, whether it be in the small intestine or the large intestine, transmitted to the prostate and we don’t know the answer to that, but we are using mouse models to currently study it and what it does seem in an acute inflammatory bowel disease mouse model; that the inflammation of the gut is transmitted to the prostate.
The question is, why is that being translated to an increased risk for prostate cancer? And we are in the process of studying that as we speak.
Host: So, interesting. Dr. Kundu, as we wrap up, what would you like other providers to know about this correlation and when you feel it’s important that they refer to the specialists at Northwestern Medicine?
Dr. Kundu: I think this is a very interesting piece of information that I think primary care doctors need to know and GI doctors or gastroenterologists need to know because they may not be aware of the association. And I think if a man elects to have prostate cancer screening and they have an elevated PSA; it really should be an indicator that they need to be referred to a urologist for an evaluation because not all elevated PSA is related to gut inflammation. And I really think that the take home message is if a man chooses to have prostate cancer screening and he has inflammatory bowel disease; don’t assume that some abnormality on the prostate exam or abnormality on the PSA serum test is just a false result. Send them to the urologist so they can get appropriately screened, have an appropriate discussion, biopsy and treated if necessary.
Host: Wow, thank you so much and wish you luck in continuing research. What a fascinating topic. Thank you again for joining us. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine; head on over to our website at www.nm.org to get connected with one of our providers. If you found this podcast as educational and informative as I did; please share on social media, share with other providers. That way we are all learning about this exciting research together. And be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.