Korean J Urol.  2012 Feb;53(2):109-113.

Effect of Prostatitis on Lower Urinary Tract Symptoms: Retrospective Analysis of Prostate Biopsy Tissue

• Chung JH
• Yu JH
• Sung LH
• Noh CH
• Chung JY

Abstract

PURPOSE
Most patients, even some urologists, assume that prostate volume is the most important prognostic factor for lower urinary tract symptoms (LUTS). In some cases, however, prostatic inflammation is a more important factor in LUTS than is prostate volume. For this reason, comparison of the impact on LUTS of inflammation and prostate volume is an attractive issue.
MATERIALS AND METHODS
From January 2000 to May 2009, 1,065 men aged between 47 and 91 years (who underwent transrectal ultrasound-guided prostate needle biopsy and transurethral prostatectomy) were retrospectively investigated. Components such as age, serum prostate-specific antigen (PSA) level, prostate volume, and the presence of prostatitis were investigated through independent-sample t-tests, chi-square tests, and univariate and multivariate analyses.
RESULTS
Chi-square tests between prostatitis, prostate volume, serum PSA, and severe LUTS showed that prostate volume (R=0.173; p=0.041) and prostatitis (R=0.148; p<0.001) were related to LUTS. In particular, for a prostate volume under 50 ml, prostatitis was a stronger risk factor than was prostate volume. Among the multivariate predictors, prostatitis (odds ratio [OR]: 1.945; p<0.001) and prostate volume (OR, 1.029; p<0.001) were found to be aggravating factors of LUTS.
CONCLUSIONS
For patients with prostate volume less than 50 ml, prostatitis was found to be a more vulnerable factor for LUTS. For those with prostate volume over 50 ml, on the other hand, the volume itself was a more significant risk factor than was prostatitis. In conclusion, the presence of prostatitis is one of the risk factors for LUTS with increased prostate volume.

Keyword

Inflammation; Prostate; Prostatic hyperplasia

MeSH Terms

Aged
Biopsy
Biopsy, Needle
Hand
Humans
Inflammation
Lower Urinary Tract Symptoms
Male
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia
Prostatitis
Retrospective Studies
Risk Factors
Urinary Tract
Prostate-Specific Antigen

Reference

1. Chute CG, Panser LA, Girman CJ, Oesterling JE, Guess HA, Jacobsen SJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol. 1993. 150:85–89.

2. Girman CJ, Jacobsen SJ, Guess HA, Oesterling JE, Chute CG, Panser LA, et al. Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol. 1995. 153:1510–1515.

3. Hammarsten J, Högstedt B, Holthuis N, Mellström D. Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 1998. 1:157–162.

4. Donnell RF. Benign prostate hyperplasia: a review of the year's progress from bench to clinic. Curr Opin Urol. 2011. 21:22–26.

5. Nickel JC. Prostatic inflammation in benign prostatic hyperplasia-the third component? Can J Urol. 1994. 1:1–4.

6. Mirone V, Imbimbo C, Longo N, Fusco F. The detrusor muscle: an innocent victim of bladder outlet obstruction. Eur Urol. 2007. 51:57–66.

7. McNeal J. Pathology of benign prostatic hyperplasia. Insight into etiology. Urol Clin North Am. 1990. 17:477–486.

8. Shin YS, Park JK. Changes in surgical strategy for patients with benign prostatic hyperplasia: 12-year single-center experience. Korean J Urol. 2011. 52:189–193.

9. Collins MM, Stafford RS, O'Leary MP, Barry MJ. Distinguishing chronic prostatitis and benign prostatic hyperplasia symptoms: results of a national survey of physician visits. Urology. 1999. 53:921–925.

10. Leskinen M, Lukkarinen O, Marttila T. Effects of finasteride in patients with inflammatory chronic pelvic pain syndrome: a double-blind, placebo-controlled, pilot study. Urology. 1999. 53:502–505.

11. Robert G, Salagierski M, Schalken JA, de La Taille A. Inflammation and benign prostatic hyperplasia: cause or consequence? Prog Urol. 2010. 20:402–407.

12. Kim GW, Doo SW, Yang WJ, Song YS. Effects of obesity on prostate volume and lower urinary tract symptoms in Korean men. Korean J Urol. 2010. 51:344–347.

13. Loeb S, Kettermann A, Carter HB, Ferrucci L, Metter EJ, Walsh PC. Prostate volume changes over time: results from the Baltimore longitudinal study of aging. J Urol. 2009. 182:1458–1462.

14. Tsukamoto T, Masumori N, Rahman M, Crane MM. Change in international prostate symptom score, prostate-specific antigen and prostate volume in patients with benign prostate hyperplasia followed longitudinally. Int J Urol. 2007. 14:321–324.

15. Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur Urol. 2007. 54:1379–1384.

16. Neal DE Jr, Clejan S, Serma D, Moon TD. Prostate-specific antigen and prostatitis I, Effect of prostatitis on serum PSA in human and nonhuman primate. Prostate. 1992. 20:105–111.

17. Nadler RB, Hymphrey PA, Smith DS, Catalona WJ, Ratiff TL. Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol. 1995. 154:407–413.

18. Haidinger G, Temml C, Schatzl G, Brössner C, Roehlich M, Schmidbauer CP, et al. Risk factors for lower urinary tract symptoms in elderly men. For the Prostate Study Group of the Austrian Society of Urology. Eur Urol. 2000. 37:413–420.

19. Meares EM Jr. Prostatitis. Med Clin North Am. 1991. 75:405–424.

20. Kanao K, Kikuchi E, Nakashima J, Horiguchi Y, Nakagawa K, Oya M, et al. Three-dimensional ultrasonography in evaluation of benign prostatic hyperplasia. Int J Urol. 2004. 11:1087–1091.

21. Pontari MA, Joyce GF, Wise M, McNaughton-Collins M. Urologic Diseases in America Project. Prostatitis. J Urol. 2007. 177:2050–2057.

22. Fibbi B, Penna G, Morelli A, Adorini L, Maggi M. Chronic inflammation in the pathogenesis of benign prostatic hyperplasia. Int J Androl. 2010. 33:475–488.

23. Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, et al. EAU guideline on chronic pelvic pain. Eur Urol. 2010. 57:35–48.

24. McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis; a systematic review. Ann Intern Med. 2000. 133:367–381.

25. Nickel JC, Downey J, Johnston B, Clark J. Canadian Prostatitis Research Group. Predictors of patient response to antibiotic therapy for the chronic prostatitits/chronic pelvic pain syndrome:a prospective multicenter clinical trial. J Urol. 2001. 165:1539–1544.

26. Chuang YC, Yoshimura N, Wu M, Huang CC, Chiang PH, Tyagi P, et al. Intraprostatic capsaicin injection as a novel model for nonbacterial prostatitis and effects of botulinum toxin A. Eur Urol. 2007. 51:1119–1127.