Detection of BK Virus Cytopathic Effect in Urine Samples of Sudanese Patients with Prostatic Cancer

Abstract

Background: Prostate cancer is one of the most common cancers among men. Some studies suggest a potential link between BK virus infection and the development of this cancer, highlighting the need for further investigation. Objectives: This study aims to detect BK virus in the urine of prostate cancer patients, examine associated cytomorphological changes, identify predisposing factors for infection, and evaluate the diagnostic value of urine cytology in benign prostatic hyperplasia (BPH). Methods: A case–control study was conducted from January to April 2025 at the Shendi Town Oncology and Cancer Treatment Center and Al Mak Nimir Hospital, enrolling 45 men (15 prostate cancer, 15 BPH, 15 healthy controls). Midstream urine samples (50–100 mL) were collected, processed within two hours (or fixed with 50% ethanol), centrifuged, and smears stained by Papanicolaou (with H&E as needed) to detect decoy cells and cytomorphological changes. Clinical and demographic data were gathered through a questionnaire, and statistical analysis (including frequencies, percentages, and p-values) was performed using SPSS. Results: Decoy cells were identified in 86.7% of prostate cancer patients, 40% of BPH cases, and 0% of healthy controls, demonstrating a strong association with malignancy. Their presence significantly correlated with hyperkeratosis (60%), inflammatory cells (83.3%), and bacterial infection (93.3%) (all P < 0.05). Clinically, decoy cells were linked to recurrent UTIs in 87% of prostate cancer patients but showed no relationship with family history. These data underscore the potential impact of BK virus–related and infectious factors over genetic predisposition in prostatic disease. Conclusion: This study highlights a strong connection between BK virus (BKV) and prostate cancer, with decoy cells frequently observed in cancer cases. These cells were associated with cytological abnormalities and infections, suggesting viral reactivation. Urine cytology proved more effective than PCR in some instances. No genetic link was found, emphasizing environmental factors. Findings support prior studies and advocate for further research into BKV as a diagnostic or therapeutic target.