Association between periodontitis severity and prostate-specific antigen levels using the NHANES data.

[BACKGROUND] Periodontitis has been linked to various systemic health conditions. This study investigated whether the association between periodontitis and prostate-specific antigen (PSA) is direct or mediated through intermediary systemic diseases.

[METHODS] Three data cycles (2001-2002, 2003-2004, and 2009-2010) from the National Health and Nutrition Examination Survey (NHANES) comprising 12,874 subjects were included, and 3020 male participants were analyzed for demographic information, periodontal health indicators, systemic conditions, PSA, and C-reactive protein (CRP) levels. The severity of periodontitis was assessed based on tooth loss, the 2012 Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) severity, the 2017 European Federation of Periodontology (EFP)/AAP Workshop stage, and a composite outcome of stage and open pocket percentage. Multilevel stepwise regression analysis examined the association between periodontitis severity (expressed by staging and open pocket percentage) and total PSA levels. Mediation analysis explored potential mediators affecting PSA levels, such as calcium (Ca) levels, osteoporosis, arthritis, and CRP. Logistic regression models were also used to assess the likelihood of elevated PSA levels based on different thresholds (>2 ng/mL, >2.5 ng/mL, >4 ng/mL). Additionally, the data from a complete follow-up survey of 58 patients from the 2003-2004 cycle were included in the analysis.

[RESULTS] The study revealed a marginal association between the composite outcome and total PSA levels (p < 0.05). However, logistic regression failed to establish significant associations between periodontitis indicators and elevated PSA levels. Mediation analysis demonstrated that Ca levels, osteoporosis, arthritis, and CRP did not significantly mediate this relationship. The follow-up revealed that edentulous patients were more likely to require additional prostate therapy.

[CONCLUSION] There is a marginal association between periodontitis severity and total PSA levels with no significant mediation through factors such as Ca levels, osteoporosis, arthritis, or CRP. Longitudinally, edentulous patients were more likely to require more invasive prostate therapy in the future.

[PLAIN LANGUAGE SUMMARY] Periodontitis is an inflammatory condition known to be associated with systemic health. This study aimed to investigate a potential association between periodontitis and prostate cancer, focusing on levels of prostate-specific antigen (PSA), a marker used in prostate cancer screening. Age, race, periodontitis severity, and open pocket percentage were significantly associated with total PSA levels. However, this increase did not significantly correlate with the defined PSA cutoff points of 2, 2.5, and 4. Additionally, calcium levels, osteoporosis, arthritis, and C-reactive protein levels as potential mediators did not significantly impact this relationship. Moreover, edentulous patients were significantly associated with higher odds of needing further treatment for prostate disease. Hence, while considering cases where periodontal disease may contribute to systemic prostate issues, implementing a dual-therapy strategy that addresses both the local inflammation as well as the systemic effects of periodontal disease might be a more effective approach in the management of these conditions.