Association of EBV infection with increased cancer aggressiveness in prostate cancer patients: A systematic review and meta-analysis.

[BACKGROUND] Several studies have reported the presence of Epstein-Barr virus (EBV) in prostate carcinoma tissues and have investigated how EBV might contribute to prostate cancer (PCa) development. To the best of our knowledge, no comprehensive systematic review and meta-analysis have been performed to: 1) estimate the pooled prevalence of EBV in PCa, particularly in samples with high and low Gleason scores; and 2) examine the association between EBV and PCa aggressiveness, measured using high-grade and/or Gleason scores.

[OBJECTIVES] This study aimed to achieve 2 primary objectives: 1) to estimate the pooled prevalence of EBV in PCa; and 2) to determine the association between EBV infection and cancer aggressiveness, specifically in relation to moderate-to-high Gleason scores (7 and above).

[MATERIAL AND METHODS] PubMed, Embase, and Google Scholar were systematically searched for relevant observational studies on EBV and PCa from database inception through December 31, 2024. The quality of the studies was assessed using the JBI criteria based on study design. A meta-analysis was conducted using 9 and 4 studies, respectively, to estimate the pooled EBV prevalence and the association between EBV infection and Gleason scores, along with 95% confidence and prediction intervals.

[RESULTS] A total of 9 studies were included in the analysis. The pooled EBV prevalence among 927 PCa samples was estimated at 33% (95% confidence interval (95% CI): 16-52%; I2 = 94.17%), while EBV prevalence in PCa samples with moderate-to-high (≥7) and low (6) Gleason scores was 59% (95% CI: 21-92%; I2 = 90.86%) and 34% (95% CI: 15-56%; I2 = 0.00%), respectively. Similarly, EBV presence in PCa samples was associated with increased odds of moderate-to-high Gleason scores (odds ratio (OR) = 2.38, 95% CI: 1.82-3.13, I2 = 0.00%, p = 0.002).

[CONCLUSION] This study highlights EBV as a possible risk factor for aggressive prostate cancer (PCa). Additional research is necessary to explore how EBV proteins contribute to PCa development.