European Urology: Relationship Between Prostate Information And LUTS Evident

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 10 Nov 2008 - 8:00 PST

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In the December issue of European Urology, Dr. Curtis Nickel and associates report on the evidence of a relationship between prostate inflammation and lower urinary tract symptoms (LUTS) in men enrolled in the REDUCE trial .

The REDUCE (Reduction by DUtasteride of prostate Cancer Events) trial is a 4-year, phase-III placebo-controlled study that evaluates whether dutasteride (a 5-alpha-reductase inhibitor, a drug which inhibits the conversion of testosterone into dihydrotestosterone (DHT); the latter may cause benign prostatic obstruction) decreases the risk of biopsy detectable prostate cancer.

The trial enrols men with a negative prostate biopsy and follows them for 4 years on either dutasteride or placebo.

Dr Curtis Nickel: "The data from the entrance biopsy have enabled additional investigations to be made, including examination of the relationship between prostate inflammation and LUTS."

Eligible men were aged 50-75 years, with Prostate Specific Antigen ≥2.5 and ≤10ng/ml (ages 50-60) or ≥3 and ≤10ng/ml (age >60 years) and an IPSS <25 (or <20 if already on an alpha blocker). During this study LUTS is measured with the International Prostate Symptom Score (IPSS). This was correlated with the presence and degree of acute or chronic histological inflammation on the initial negative prostate biopsy.

The study is remarkable for its scope, which includes data on 8,224 men. A majority, 77.6 % had chronic inflammation at baseline. The authors note small differences in age, serum PSA, and prostate size in those with and without histological inflammation.

Total IPSS score and subscores were higher in the group of patients with chronic inflammation at baseline compared to those with no chronic inflammation. The differences were small, but statistically significant. Statistically significant correlations were also found between average chronic inflammation score and the IPSS variables. However, the magnitude of these correlations was small indicating a weak association. A regression analysis was performed and included age, body mass index (BMI), and acute and chronic inflammation. It revealed that higher values of age and average chronic inflammation were significantly associated with higher IPSS scores. BMI and average acute inflammation did not contribute to the relationship in a statistically significant fashion.

Dr Curtis Nickel: "The study entry criteria that selected older men and decreased enrolment of men with a greater degree of inflammation and LUTS may have limited the strength of the relationship between the degree of chronic inflammation and LUTS. It may actually be stronger."

The impact of baseline prostate inflammation on progression of LUTS and/or associated complications will be determined during a 4-year follow-up study.

The article The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial by Curtis Nickel J, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS can be viewed online at http://www.europeanurology.com.

EAU, CUA collaborate for 1st CUREP in Shanghai

As part of the ongoing collaboration between the European Association of Urology (EAU) and the Chinese Urology Association (CUA), the first EAU-CUA joint course, the Chinese Urological Resident Education Programme (CUREP), will be held from 21 to 23 November 2008 in Shanghai. The course is organised by the European School of Urology and the Chinese School of Urology, the educational offices of both organisations.

CUREP will enroll 120 young Chinese urologists. The course will be presented in English and the EAU faculty will include Prof. Christopher Chapple (United Kingdom), Prof. Walter Artibani (Italy), Prof. Manfred Wirth (Germany) and Prof. Didier Jacqmin (France). Representing the CUA, eight urology experts from China will join their European colleagues. They are Dr. Liping Xie (Hangzhou), Dr. Yong Yang (Beijing), Dr. Dingwei Ye (Shanghai), Dr. Ningchen Li (Beijing), Dr. Kexing Xu (Beijing), Dr. Gang Zhu (Beijing), Kunjie Wang (Chengdu) and Dr. Jian Lin (Beijing).

The joint CUREP programme represents some of the important new initiatives to help boost urological education worldwide. The programme, organised at the Shanghai International Convention Center, is similar to that of EUREP held in Prague from 5-10 September and consists of lectures, discussions, hands-on-training and a competition.

The programme consist of:

Course 1 - Retropubic radical prostatectomy - tips, tricks and pitfalls
Course 2 - Evaluation and management of female pelvic floor disorders
Course 3 - Management of small renal tumours
Course 4 - Advanced course on urethral stricture surgery.

The workshops on laparoscopy hands-on-training are supported by Olympus and co-supervised by Dr. Ben van Cleynenbreugel from Belgium and Dr. Jianguang Qiu (Guangzhou).

European Association of Urology