Relationship seen between chronic inflammation, LUTS

Key Points

Berlin-Preliminary results from the REDUCE (REduction by DUtasteride of prostate Cancer Events) trial suggest a relationship between the degree of chronic inflammation and lower urinary tract symptoms, 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 findings presented at the European Association of Urology annual congress here.

J. Curtis Nickel, MD, professor of urology at Kingston General Hospital, Kingston, Ontario, Canada, reported on the baseline data of the 4-year, ongoing, multicenter, multinational, 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.

Histologic findings, symptoms

The results showed that the degree of histologic inflammation did not correlate at all with symptoms of clinical prostatitis. 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.

These results seem to be paradoxical, at least to traditional dogma, as histologic inflammation does not appear to be related to the syndrome known as chronic prostatitis, but it is more related to the syndrome known as LUTS, according to Dr. Nickel.

"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. So this is exciting baseline data that is going to evolve over the next 4 years into perhaps something more important."