Comparison of the ESR and CRP levels and their relationship with PSA in benign prostate hyperplasia and prostate adenocarcinoma patients: A retrospective analytical study

Shokouh Taghipour Zahir, Mohammad Sadegh Raeeszadeh, Farzan Safi Dahaj, Koorosh Rahmani, Mehrdad Roozbeh


Prostate cancer is the most common malignancy (excluding skin malignancies) in men. Chronic inflammation has been shown to be associated with cancer. Although this association has not been proven for prostate cancer, evidence shows that inflammation has a possible role in prostate cancer. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are the two key indices in assessing inflammation. It was therefore decided to investigate ESR and CRP in patients with prostate cancer and assess their relationship with PSA level at initial diagnosis. In this retrospective-analytical study, hospital records of all patients referred to Mortaz and Shahid Rahnemoon general hospitals during 2013-2018 and undergoing prostatectomy with pathology reports of benign prostatic hyperplasia or prostate adenocarcinoma were extracted by census method. The required variables including patient’s age, PSA, ESR and CRP levels were extracted from hospital records. Extracted data were analyzed by ANOVA and Chi-square tests in SPSS software version 18. P-value <0.05 was considered statistically significant. According to the results, patients' mean age was 70.71±10.19 years, mean ESR 38.86±31.28, and mean CRP 1.28±1.01. There was a significant difference between the two groups in mean values of ESR and CRP (P<0.05). The results also showed meaningful correlations between age and PSA, ESR and PSA, CRP and PSA, and CRP and ESR in patients with prostate cancer (P<0.05). As inflammatory factors, ESR and CRP increase in patients with prostate cancer, they can be used in the initial diagnosis of prostate cancer as an adjunct diagnostic assay and prognostic factor (only ESR) in conjunction with PSA.


Neoplasm, prostate, blood sedimentation, inflammation

Full Text:



Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 62:10-29, 2012.

Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 16:481-488, 2005.

Attard G, Reid AHM, Yap TA, Raynaud F, Dowsett M, Settatree S, et al. Phase I Clinical Trial of a Selective Inhibitor of CYP17, Abiraterone Acetate, Confirms That Castration-Resistant Prostate Cancer Commonly Remains Hormone Driven. J Clin Oncol 26:4563-4571, 2008.

Kantoff PW, Higano CS, Shore ND, Berger ER, Small EJ, Penson DF, et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 63:411-422, 2010.

Pezaro C, Attard G. Prostate cancer in 2011: redefining the therapeutic landscape for CRPC. Nat Rev Urol 9:63-64, 2012.

Aus G, Robinson D, Rosell J, Sandblom G, Varenhorst E. Survival in prostate carcinoma—Outcomes from a prospective, population-based cohort of 8887 men with up to 15 years of follow-up. Cancer 103:943-951, 2005.

Platz EA, De Marzo AM. Epidemiology of inflammation and prostate cancer. J Urol 171:S36-S40, 2004.

Hussain SP, Hofseth LJ, Harris CC. Radical causes of cancer. Nat Rev Cancer 3:276, 2003.

Lucia MS, Torkko KC. Inflammation as a Target for Prostate Cancer Chemoprevention: Pathological and Laboratory Rationale. J Urol 171:S30-S35, 2004.

Aldemir M, Ener K, Dehni D, Ağras K, Kayıgil Ö. Evaluation of the Relationship between Prostate Cancer and Serum inflammation Markers. Nephro Urol Mon 2:244-250, 2010.

Saadeh C. The erythrocyte sedimentation rate: old and new clinical applications. South Med J 91:220-225, 1998.

Autrup JL, Thomassen LH, Olsen JH, Wolf H, Autrup H. Glutathione S-transferases as risk factors in prostate cancer. Eur J Cancer Prev 8:525-532, 1999.

Hannisdal E, Engan T. Blood analyses and survival in symptom- and survey-detected lung cancer patients. J Intern Med 229:337-341, 1991.

Hannisdal E, Fosså SD, Høst H. Blood tests and prognosis in bladder carcinomas treated with definitive radiotherapy. Radiother Oncol 27:117-122, 1993.

Hannisdal E, Gundersen S, Kvaloy S, Lindegaard MW, Aas M, Finnanger AM, et al. Follow-up of breast cancer patients stage I-II: a baseline strategy. Eur J Cancer 29a:992-997, 1993.

Hannisdal E, Tveit KM, Theodorsen L, Host H. Host markers and prognosis in recurrent rectal carcinomas treated with radiotherapy. Acta Oncol 33:415-421, 1994.

Imai K, Suzuki T, Kobayashi M, Yamanaka H, Tomaru Y, Sato J. The Significance of Erythrocyte Sedimentation Rate as a Prognostic Factor for Patients with Prostate Cancer: Gunma Urological Oncology Study Group Investigation. Jpn J Cancer Res 81:971-974, 1990.

Jakobsen EB, Eickhoff JH, Andersen JP, Ottesen M. Prognosis After Nephrectomy for Renal Cell Carcinoma. Scand J Urol Nephrol 28:229-236, 1994.

Johansson JE, Sigurdsson T, Holmberg L, Bergstrom R. Erythrocyte sedimentation rate as a tumor marker in human prostatic cancer. An analysis of prognostic factors in 300 population-based consecutive cases. Cancer 70:1556-1563, 1992.

Borre M, Nerstrom B, Overgaard J. Erythrocyte sedimentation rate--a predictor of malignant potential in early prostate cancer. Acta Oncol 36:689-694, 1997.

Trautner K, Cooper EH, Haworth S, Ward AM. An evaluation of serum protein profiles in the long-term surveillance of prostatic cancer. Scand J Urol Nephrol 14:143-149, 1980.

Ward AM, Copper EH, Houghton AL. Acute Phase Reactant Proteins in Prostatic Cancer. Br J Urol 49:411-418, 1977.

Latif Z, McMillan DC, Wallace AM, Sattar N, Mir K, Jones G, et al. The relationship of circulating insulin-like growth factor 1, its binding protein-3, prostate-specific antigen and C-reactive protein with disease stage in prostate cancer. Br J Urol 89:396-399, 2002.

Garcia Rodriguez LA, Gonzalez-Perez A. Inverse association between nonsteroidal anti-inflammatory drugs and prostate cancer. Cancer Epidemiol Biomarkers Prev 13:649-653, 2004.

Mahmud S, Franco E, Aprikian A. Prostate cancer and use of nonsteroidal anti-inflammatory drugs: systematic review and meta-analysis. Brit J Cancer 90:93, 2004.

Chang C-C, Lin ATL, Chen K-K, Chung H-J, Chang S-C. The Significance of Plasma C-reactive Protein in Patients With Elevated Serum Prostate-specific Antigen Levels. Urol Sci 21:88-92, 2010.

Eklund CM, Tammela TLJ, Schleutker J, Hurme M. C-reactive protein haplotype is associated with high PSA as a marker of metastatic prostate cancer but not with overall cancer risk. Brit J Cancer 100:1846-1851, 2009.

Yan B, Meng X, Wang X, Wei P, Qin Z. Complete regression of advanced prostate cancer for ten years: A case report and review of the literature. Oncol Lett 6:590-594, 2013.

Graff Julie N, Beer Tomasz M. The role of C-reactive protein in prostate cancer. Cancer 119:3262-3264, 2013.

Graff JN, Beer TM, Liu B, Sonpavde G, Taioli E. Pooled Analysis of C-Reactive Protein Levels and Mortality in Prostate Cancer Patients. Clin Genitourin Cancer 13:e217-e21, 2015.

Mikkola A, Aro J, Rannikko S, Ruutu M. Prognostic grouping of metastatic prostate cancer using conventional pretreatment prognostic factors. Scand J Urol Nephrol 43:265-270, 2009.

Kim Y, Jeon Y, Lee H, Lee D, Shim B. The Prostate Cancer Patient Had Higher C-Reactive Protein Than BPH Patient. Korean J Urol 2013;54:85-88.

Putra IB, Hamid AR, Mochtar CA, Umbas R. Relationship of age, prostate-specific antigen, and prostate volume in Indonesian men with benign prostatic hyperplasia. Prostate Int 4:43-48, 2016.

Yun J, Lee H, Yang W. Association between systemic inflammation and serum prostate-specific antigen in a healthy Korean population. Turk J Urol 43:284-288, 2017.


  • There are currently no refbacks.