Examination of the Relationship Between Symptoms of Prostatitis and Histological Inflammation: Baseline Data From the REDUCE Chemoprevention Trial
Abstract
Purpose:
Symptoms of abacterial chronic prostatitis/chronic pelvic pain syndrome are considered to be associated with prostate inflammation. The ongoing Reduction by Dutasteride of Prostate Cancer Events trial is a 4-year, phase III, placebo controlled study to determine whether 0.5 mg dutasteride daily decreases the risk of biopsy detectable prostate cancer. All men underwent biopsy before study entry, allowing review of the relationship between histological prostate inflammation and prostatitis symptoms.
Materials and Methods:
Eligible men were 50 to 75 years old with serum prostate specific antigen 2.5 ng/ml or greater and 10 ng/ml or less (ages 50 to 60 years), or 3.0 ng/ml or greater and 10 ng/ml or less (older than 60 years), and an International Prostate Symptom Score of less than 25 (or less than 20 if already on α-blocker therapy). Acute prostatitis was an exclusion criterion. The National Institutes of Health Chronic Prostatitis Symptom Index was used to assess prostatitis-like symptoms. Spearman rank correlations were used to assess the relationship between acute and chronic inflammation, and Chronic Prostatitis Symptom Index scores for the pain, urinary symptoms and quality of life domains as well as average pain, total score and prostatitis-like symptoms.
Results:
Data were available on 5,597 patients. The distribution of inflammation status was similar for those with and without chronic prostatitis-like symptoms. Significant correlations were found between average chronic inflammation, and total Chronic Prostatitis Symptom Index score and subscores for urinary symptoms and quality of life but the magnitude of these correlations was small.
Conclusions:
A lack of clinically meaningful association was found between prostatitis-like pain symptoms and histological inflammation in the Reduction by Dutasteride of Prostate Cancer Events population, suggesting that the view that symptoms of chronic prostatitis/chronic pelvic pain syndrome and prostate inflammation are associated needs further scrutiny.
References
- 1 : NIH consensus definition and classification of prostatitis. JAMA1999; 282: 236. Crossref, Medline, Google Scholar
- 2 : The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. J Urol1999; 162: 369. Link, Google Scholar
- 3 : Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol1999; 162: 2014. Link, Google Scholar
- 4 : Chemoprevention of prostate cancer in men at high risk: rationale and design of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial. J Urol2004; 172: 1314. Link, Google Scholar
- 5 : Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol2001; 165: 842. Link, Google Scholar
- 6 : Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU Int2001; 87: 797. Google Scholar
- 7 : Patterns of inflammation in prostatic hyperplasia: a histologic and bacteriologic study. J Urol1979; 121: 755. Link, Google Scholar
- 8 : Prostatic inflammation in benign prostatic hyperplasia—the third component?. Can J Urol1994; 1: 1. Google Scholar
- 9 : Chronic prostatitis in benign prostatic hyperplasia. Br J Urol1971; 43: 333. Google Scholar
- 10 : The impact of acute and chronic inflammation in baseline biopsy on the risk of clinical progression of BPH: results from the MTOPS study. J Urol, suppl2005; 173: 346. abstract 1277. Link, Google Scholar
- 11 : Relation between acute urinary retention, chronic prostatic inflammation and accompanying elevated prostate-specific antigen. Scand J Urol Nephrol2006; 40: 155. Google Scholar
- 12 : Influence of asymptomatic histologic prostatitis on serum prostate-specific antigen: a prospective study. Urology2004; 64: 1098. Google Scholar
- 13 : Correlation of histological inflammation in needle biopsy specimens with serum prostate-specific antigen levels in men with negative biopsy for prostate cancer. Urology2000; 55: 892. Google Scholar
- 14 : Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol2003; 170: 818. Link, Google Scholar
- 15 : Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. J Urol2002; 168: 1048. Link, Google Scholar
- 16 : The three As of chronic prostatitis therapy: antibiotics, alpha-blockers and anti-inflammatories: What is the evidence?. BJU Int2004; 94: 1230. Google Scholar
- 17 : Effects of finasteride in patients with inflammatory chronic pelvic pain syndrome: a double-blind, placebo-controlled, pilot study. Urology1999; 53: 502. Google Scholar
- 18 : A randomized placebo-controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis). BJU Int2004; 93: 991. Google Scholar
- 19 : The influence of finasteride on the development of prostate cancer. N Engl J Med2003; 349: 215. Google Scholar
