Cancer Causes & Control

, Volume 30, Issue 12, pp 1293–1300 | Cite as

The association between clinically determined periodontal disease and prostate-specific antigen concentration in men without prostate cancer: the 2009–2010 National Health and Nutrition Examination Survey

  • Yuhan Huang
  • Dominique S. Michaud
  • Jiayun Lu
  • H. Ballentine Carter
  • Elizabeth A. PlatzEmail author
Original Paper



We evaluated the association between clinically assessed periodontal disease and serum prostate-specific antigen (PSA) concentration in men without a prostate cancer diagnosis in a US nationally representative sample of non-institutionalized men.


Included were 1263 men aged ≥ 40 years who participated in the National Health and Nutrition Examination Survey in 2009–2010. Measurements of periodontal health and tooth count were used to define periodontal disease severity (no, mild, moderate, severe) and edentulism. Linear and logistic regressions were used to estimate the association of periodontal disease severity and edentulism with PSA concentration and elevated PSA, respectively.


Adjusting for age and other factors including race, body mass index, and education, the natural logarithm of PSA concentration did not change with increasing severity (mild − 0.20, 95% confidence interval [CI] − 0.34 to − 0.05; moderate − 0.12, 95% CI − 0.26 to 0.01; severe − 0.16, 95% CI − 0.43 to 0.12; edentulism − 0.16, 95% CI − 0.35 to 0.04; P-trend 0.13) compared with dentate men without periodontal disease. Although the multivariable-adjusted ORs of elevated PSA were not statistically significant, participants with more severe periodontal disease were less likely to have PSA > 2.0 and > 2.5 ng/mL, but more likely to have PSA > 4.0 ng/mL, compared to dentate men without periodontal disease. Similar non-significant associations with PSA were observed when comparing edentulous men to dentate men without periodontal disease.


In this US nationally representative sample, men with periodontal disease did not have higher serum PSA and were not more likely to have clinically elevated PSA after taking into account age and other factors, contrary to the hypothesis. This study suggests that periodontal disease does not notably affect the specificity of PSA for prostate cancer screening.


Periodontal disease PSA Men NHANES 



This work was supported in part by the National Cancer Institute (P30 CA006973, Nelson) and the Maryland Cigarette Restitution Fund at Johns Hopkins.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Thompson IM, Pauler DK, Goodman PJ et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤ 4.0 ng per milliliter. N Engl J Med 350(22):2239–2246CrossRefGoogle Scholar
  2. 2.
    Barry MJ (2001) Clinical practice. Prostate-specific-antigen testing for early diagnosis of prostate cancer. N Engl J Med 344(18):1373–1377CrossRefGoogle Scholar
  3. 3.
    Nadler RB, Humphrey PA, Smith DS, Catalona WJ, Ratliff TL (1995) Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 154:407–413CrossRefGoogle Scholar
  4. 4.
    Haffajee AD, Socransky SS (2000) Microbial etiological agents of destructive periodontal diseases. Periodontol 1994(5):78–111Google Scholar
  5. 5.
    Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS (2000) Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 1997(14):216–248Google Scholar
  6. 6.
    Joshi N, Bissada NF, Bodner D et al (2010) Association between periodontal disease and prostate-specific antigen levels in chronic prostatitis patients. J Periodontol 81:864–869CrossRefGoogle Scholar
  7. 7.
    Alwithanani N, Bissada NF, Joshi N et al (2015) Periodontal treatment improves prostate symptoms and lowers serum PSA in men with High PSA and chronic periodontitis. Dentistry 05:284.Google Scholar
  8. 8.
    Kruck S, Hennenlotter J, Amend B et al (2017) Chronic periodontitis does not impact serum levels of prostate-specific antigen. Anticancer Res 37:3163–3167PubMedGoogle Scholar
  9. 9.
    Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ (2018) Periodontitis in US adults: National Health and Nutrition Examination Survey 2009-2014. J Am Dent Assoc 149(576–588):e576CrossRefGoogle Scholar
  10. 10.
    Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J (2013) National health and nutrition examination survey: plan and operations, 1999–2010. Vital Health Stat 1:1–37Google Scholar
  11. 11.
    Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Examination Protocol. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. site]. Available at
  12. 12.
    Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ (2012) Update of the case definitions for population-based surveillance of periodontitis. J Periodontol 83:1449–1454CrossRefGoogle Scholar
  13. 13.
    Gilbert SM, Cavallo CB, Kahane H, Lowe FC (2005) Evidence suggesting PSA cutpoint of 2.5 ng/mL for prompting prostate biopsy: review of 36,316 biopsies. Urology 65(3):549–553CrossRefGoogle Scholar
  14. 14.
    Michaud DS, Liu Y, Meyer M, Giovannucci E, Joshipura K (2008) Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncol 9:550–558CrossRefGoogle Scholar
  15. 15.
    Michaud DS, Lu J, Peacock-Villada AY et al (2018) Periodontal disease assessed using clinical dental measurements and cancer risk in the ARIC Study. J Natl Cancer Inst 110:843–854CrossRefGoogle Scholar
  16. 16.
    Lee JH, Kweon HH, Choi JK, Kim YT, Choi SH (2017) Association between periodontal disease and prostate cancer: results of a 12-year longitudinal cohort Study in South Korea. J Cancer. 8:2959–2965CrossRefGoogle Scholar
  17. 17.
    Cheng WC, Saleh F, Abuaisha Karim B, Hughes FJ, Taams LS (2018) Comparative analysis of immune cell subsets in peripheral blood from patients with periodontal disease and healthy controls. Clin Exp Immunol 194:380–390CrossRefGoogle Scholar
  18. 18.
    Sabarish R, Rao SR, Lavu V (2016) Natural T regulatory cells (n Treg) in the peripheral blood of healthy subjects and subjects with chronic periodontitis—a pilot study. J Clin Diagn Res 10(3):ZC36PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Public Health and Community MedicineTufts University School of MedicineBostonUSA
  3. 3.Department of Urology and the James Buchanan Brady Urological InstituteJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimoreUSA

Personalised recommendations