Acne And Prostate Cancer
Acne is a major downer that most men forget. But it turns out that men who have been free of acne for 50 years and more may still suffer one of the most serious after-effects of acne1 in the form of an increased risk for prostate cancer.
Propionibacterium acnes is the species of bacteria that is involved in acne. Strictly speaking, Propionibacterium acnes does not cause any kind of swelling, inflammation, or redness that we see as pimples. It’s actually the immune system’s attack on the bacterium, which has the capability of creating chemicals known as chemotactins that direct the immune attack to nearby skin, that causes the outward manifestations of the disease.
Small numbers of acne bacteria can find their way into the bloodstream. It is very unusual for acne bacteria to involved in disease anywhere in the body other than the skin itself, although sometimes the bacteria colonize inside the bones, eyes, brain, mouth2, or, in men, the prostate.
The way acne bacteria get into the body is usually through catheters or during surgery. Small numbers of acne bacteria live all over the body, consuming excess skin oil. Most of the time these microbes are actually beneficial, preventing the accumulation of excess skin oil in pores.
When acne bacteria hitch a ride on a catheter into the urinary tract or on surgical instruments into eyes, bones, joints, or brain, however, they can cause the same kinds of tissue destruction they cause in the skin. The immune system attempts to kill the bacteria with leukotrienes but the chemotactins they produce cause antibodies to attack nearby, healthy tissue. Even if you haven’t had pimples in 50 years, you can get an acne infection inside your body. But it’s almost unheard of for these infections to get into the body on their own.
Acne Bacteria In The Prostate
Scientists noted that3 men who had acne as teenagers tend to develop prostate cancer later in life in the 1970’s. An exact correspondence between acne and prostate cancer, however, has been difficult to determine. Some men get acne and don’t get prostate cancer, and a few men get prostate cancer but never had acne.
Of the four large-scale studies of the relationship of acne and prostate cancer, two found a connection, and two did not. Researchers at first thought the relationship might really be between testosterone levels during adolescence, believed to be higher in men who had acne as teenagers, and prostate cancer later in life, but the evidence for this relationship did not pan out.
Australian researchers who did4 detailed biopsies of prostate tissue removed during prostate cancer surgery, however, noted that when the prostate was inflamed, it often was infected with acne bacteria. But they didn’t believe that acne bacteria caused prostate cancer. They theorized that once prostate cancer occurred, acne bacteria could make it much worse.
How could that be?
Not surprisingly, cancer makes the immune system much more active as it tries to kill the tumor. Acne bacteria, however, aren’t killed by the immune system. Instead, they redirect inflammation to nearby tissues. Acne bacteria increase inflammation in the prostate, which in turn gives the cancer more ways to connect to the bloodstream and more ways to spread to the rest of the body.
Also, the kinds of treatments used in most cases of prostate cancer accelerate the growth of acne bacteria. Men being treated for prostate cancer are usually given chemicals that make testosterone less abundant in their bloodstreams and estrogen more abundant in their bloodstreams. During adolescence, higher levels of testosterone are associated with more acne blemishes, but this is not due to any effect testosterone has on the acne bacteria themselves. Testosterone just causes the skin to grow faster so that more oil is produced and more pores narrow with over-production of new skin. Testosterone works on the skin itself.
Estrogen, on the other hand, stimulates bacteria. In the body, this means that more acne bacteria can release more decoy chemicals that cause more inflammation that cause greater damage from cancer. And because acne bacteria stimulate the activity5 of white blood cells known as Th1 cells, which cause delayed responses to infection, they can do far greater damage than if the inflammatory response were immediate, possibly causing men to get faster treatment. But how does acne bacteria find its way into the prostate?
Surgical Infections And Acne Bacteria
While acne bacteria can infect a man’s body during prostatectomy, the surgical removal of the prostate, they are more likely to enter the prostate either6 (1) on a catheter inserted into the man’s urethra to drain urine backed up behind a swollen prostate or (2) on the biopsy needles inserted up the rectum that are used to take 8 to 15 samples of prostate tissue to confirm a cancer diagnosis. This means that it is really, really important not to reuse catheters that have not been sterilized, and it’s important not to tug on a catheter to reinsert it. There’s not a lot you can do to achieve a sterile surgical field when you are the patient having a prostate exam, but you can avoid having biopsies at hospitals that are in budgetary crisis (and that may cut back on cleaning costs) and you can share your concerns with your physician.
There are two other ways that acne bacteria can enter the skin, and one of them is through boils and abscesses in the skin. Even if the skin lesion itself was not caused by acne bacteria, acne bacteria can travel through the break in the skin and cause infection almost anywhere in the body. Also, acne bacteria can enter the body through the gums7, usually on infected dental instruments.
Although acne bacteria accelerate the progression of prostate cancer, they actually protect the body against cancers that “break out” of tumors with the help of a different kind of white blood cell, the Th2 cell. Acne infections inside the body actually reduce the severity of melanoma and certain kinds of leukemia and lymphoma.
- Sutcliffe S., Giovannucci E., Isaacs W.B., Willett W.C., Platz E.A. Acne and risk of prostate cancer. International Journal of Cancer. 2007;121(12):2688-92.
- Perry A., Lambert P. Propionibacterium acnes: infection beyond the skin. Expert Review of Anti-Infective Therapy. 2011;9(12):1149-56.
- Ugge H., Udumyan R., Carlsson J., Andrén O., Montgomery S., Davidsson S., Fall K. Acne in late adolescence and risk of prostate cancer. International Journal of Cancer. 2018;142(8):1580-1585.
- Shannon B.A., Garrett K.L., Cohen R.J. Links between Propionibacterium acnes and prostate cancer. Future Oncology. 2006;2(2):225-32.
- Kistowska M., Meier B., Proust T., Feldmeyer L., Cozzio A., Kuendig T., Contassot E., French L.E. Propionibacterium acnes promotes Th17 and Th17/Th1 responses in acne patients. The Journal of Investigative Dermatology. 2015;135(1):110-118.
- Alexeyev O.A., Marklund I., Shannon B., Golovleva I., Olsson J., Andersson C., Eriksson I., Cohen R., Elgh F. Direct Visualization of Propionibacterium acnes in Prostate Tissue by Multicolor Fluorescent In Situ Hybridization Assay. Journal of Clinical Microbiology. 2007;45(11):3721-8.
- Niazi S.A., Al Kharusi H.S., Patel S., Bruce K., Beighton D., Foschi F., Mannocci F. Isolation of Propionibacterium acnes among the microbiota of primary endodontic infections with and without intraoral communication. Clinical Oral Investigations. 2016;20(8):2149-2160.
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