Relationship seen between chronic inflammation and LUTS

Preliminary results from the REDUCE (REduction by DUtasteride of prostate Cancer Events) trial suggest a relationship between the degree of chronic inflammation and LUTS, but not clinical prostatitis-like symptoms in the REDUCE population. Also, men with more severe LUTS are more likely to experience pelvic pain as part of their symptom complex, according to the study findings presented here yesterday.

J. Curtis Nickel, MD, of Kingston General Hospital, Kingston, Ontario, Canada, reported on the baseline data of the 4-year, ongoing, multicenter, randomized, double-blind, placebo-controlled trial, which was designed to investigate the use of dutasteride (Avodart), 0.5 mg, to reduce the risk of biopsy-detectable prostate cancer in men at high risk of developing the disease.

Entry criteria for the trial included men ages 50 to 75 years with a PSA ≥2.5 ng/mL and ≤10.0 ng/mL (50-60 years), or ≥3.0 ng/mL and ≤10 ng/ml (>60 years), and a negative prostate biopsy within 6 months prior to enrollment. More than 8,000 biopsies were included in the trial.

The degree of histologic inflammation did not correlate at all with symptoms of clinical prostatitis, researchers found. These symptoms include pain on ejaculation and perineal pain, and interestingly, they did not correlate with inflammation of the prostate.

"What did correlate, albeit only modestly, was the amount of inflammation and type of inflammation seen in the baseline biopsy with the lower urinary tract symptoms. Interestingly, we also noted that the more severe LUTS the patient had, the greater the chance that they would have prostatitis-like pain," Dr. Nickel said.

"What is going to be extremely important in this study is what happens over the next 4 years because now we have the baseline prostatic inflammation data," he said. "Is prostatic inflammation going to predict the progression of LUTS and outcomes such as acute urinary retention or surgery? Is it going to predict the development of prostatitis-like symptoms, or even predict whether or not the patient develops prostatic cancer within those 4 years? It may help predict a response to dutasteride over those 4 years in all those parameters mentioned."