The Relationship Between Prostate Inflammation And Lower Urinary Tract Symptoms: Examination Of Baseline Data From The REDUCE Trial

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 08 Feb 2008 - 0:00 PDT

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UroToday.com- In the online version of European Urology, Dr. Curtis Nickel and associates report on the association of prostate inflammation and lower urinary tract symptoms (LUTS) in men enrolled in the REDUCE trial, a 4-year, phase III placebo-controlled study that evaluates whether dutasteride (o.5mg) decreases the risk of biopsy detectable prostate cancer (CaP). They find evidence of a link between prostate inflammation and LUTS.

The REDUCE (Reduction by Dutasteride of prostate Cancer Events) enrolls men with a negative prostate biopsy and follows them for 4 years on either dutasteride or placebo. Participants were aged 50-75 years, with a PSA 2.5-10ng/ml (ages 50-60), 3-10ng/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 histologic inflammation on the initial negative prostate biopsy. Pathology was centrally reviewed.

The study is remarkable for its scope, which includes data on 8,224 men. At baseline 15.4% had acute inflammation, 77.6% had chronic inflammation, and 21.6% had no inflammation. In those with acute inflammation, it was categorized as mild in 97.9%, moderate in 1.9% and severe in 0.2%. For those with chronic inflammation it was 89%, 10.7%, and 0.3%, respectively. The authors note small differences in age, serum PSA, and prostate size in those with and without histological inflammation.

A small but statistically significant higher score was noted in the total IPSS scores of those with chronic inflammation at baseline compared to those with no chronic inflammation. Although statistically significant correlations were found between average chronic inflammation score and the IPSS variables the magnitude of these correlations was small indicating a weak association. A regression analysis was performed and included age, body mass index, 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.

The authors suggest that the weak relationship between the degree of chronic inflammation and LUTS at baseline may actually be stronger but is potentially hampered by the study entry criteria that selected older men and excluded men with clinical prostatitis or severe LUTS.

Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS

Eur Urol. ePub: November 19, 2007
doi: 10.1016/j.eururo.2007.11.026

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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