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Periodontal Treatment Improves Prostate Symptoms and Lowers Serum PSA in Men with High PSA and Chronic Periodontitis

Naif Alwithanani,Nabil F Bissada*,Nishant Joshi,Donald Bodner,Catherine Demko,Gregory T MacLennan,Robert Skillicorn,Lee Ponsky,Sanjay Gupta

Objective: To assess changes in voiding symptoms, serum PSA and inflammatory cytokine levels after non-surgical periodontal treatment in men with chronic periodontitis.

Patients and methods: Twenty-seven men who underwent prostate biopsy because of abnormal findings on digital rectal examination or elevated PSA (≥4 ng/ml) participated in the study. Dental plaque (PI) and gingival(GI) indices, bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), gingival recession(GR), PSA, IPSS, IL-1β, and C-Reactive Protein (CRP) were determined before and after periodontal treatment. The Mann-Whitney test was used to compare PSA level at baseline with prostate inflammation, prostate malignancy, and Gleason score. The Wilcoxon Rank-Sum Test was used to examine differences in baseline and post-periodontal treatment values. Change in PSA level after periodontal treatment was correlated with change in other parameters studied, using Spearman?s correlation.

Results: All clinical periodontal parameters and IPSS values showed statistically significant (P<0.05) improvement after periodontal treatment. A reduction in mean PSA levels was noted 4 to 8 weeks after treatment, but did not reach statistical significance (4.53 ? 8.16 versus 4.19 ? 7.71, P=0.13). Men having >4 ng/ml PSA levels at baseline, showed significant (P<0.05) reduction in PSA after treatment (9.7 ? 11.9 versus 8.51 ? 11.6). No significant change in CRP and IL-1βlevels (p>0.05) were found. Statistically significant correlation was found between the changes in periodontal parameters and PSA levels after periodontal treatment: CAL (r=0.57, P=0.002), BOP (r=0.42, P=0.031), GI (r=0.39, P=0.04), GR (r=0.67, P=0.001). Mean PSA levels were significantly higher (P=0.02) in men with moderate/severe prostate inflammation than in those with none/mild group (6.5 ? 3.6 versus 4.3 ? 9.1 ng/ml) regardless of the presence or severity of prostate malignancy.

Conclusion: Periodontal treatment improved prostate symptom score and lowered PSA value in men afflicted with chronic periodontitis.