NEW STUDY RADICAL PROSTATECTOMY AND SYMPTOM IMPROVEMENT

[NACHO B]

Urology. 2014 Jan;83(1):186-90. doi: 10.1016/j.urology.2013.07.080. Epub 2013 Nov 15.

Lower urinary tract symptom improvement after radical prostatectomy correlates with degree of prostatic inflammation.

Burris MB¹, Cathro HP¹, Kowalik CG², Jensen D¹, Culp SH¹, Steers WD¹, Krupski TL³.

Author information

• ¹Department of Urology, University of Virginia Health System, Charlottesville, VA.
• ²Institute of Urology, Lahey Clinic, Burlington, MA.
• ³Department of Urology, University of Virginia Health System, Charlottesville, VA. Electronic address: [e-mail].

Abstract

OBJECTIVE:

To determine if prostatic inflammation at the time of radical prostatectomy (RP) was associated with the International Prostate Symptom Score (IPSS).

METHODS:

We performed a proof of principle analytic case control study of patients who underwent RP between January 2005 and August 2008 for lower urinary tract symptoms (LUTS). We reviewed pathology slides of those who had a change of 4 points or greater, as measured by the IPSS and correlated inflammation with change in IPSS. Multivariate linear regression analyses were performed to determine the association of IPSS with degree of inflammation based on the number of inflammatory cells.

RESULTS:

Of 249 patients, 136 had complete data and 47 (18.8%) underwent pathologic review. The median change in IPSS for the study cohort was -7.0 points compared to +1.0 point for the control cohort. On univariate analysis, the average improvement in IPSS in patients with severe inflammation was (r = -6.02, 95% confidence interval [CI] -11.0 to -1.1, P = .018) after RP. On multivariate analysis, adjusting for age, body mass index (BMI), year of surgery, history of prostatitis, Gleason score, prostate-specific antigen (PSA), prostate weight, and nerve sparing status, only patients with severe prostatic inflammation had significant improvement in their IPSS (r = -5.93, 95% CI -10.81 to -1.04, P = .004).

CONCLUSION:

Prostatic inflammation measured in prostatectomy specimens is associated with worse baseline IPSS than matched cohorts. Specifically, severe inflammation is an independent predictor of IPSS improvement at 1 year after RP.

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Dr Krongrad what is your opinion about this study? If the prostate is slightly swollen but great symptomatology, is not effective prostatectomy?